Late reoperations after repair of tetralogy of Fallot

Abstract

Twenty-two patients underwent 23 late reoperations after total correction of tetralogy of Fallot from 1965 to 1990. Indications for reoperation included: isolated ventricular septal defect (VSD) in 9 patients (41%), isolated right ventricular outflow tract (RVOT) obstruction in 3 patients (13.7%), VSD associated with a RVOT obstruction in 7 patients (31.8%), aneurysm of the pericardial RVOT patch in 1 patient (4.5%), aortic insufficiency with a residual VSD in 1 patient (4.5%), and tricuspid regurgitation in 1 patient (4.5%). The reoperation consisted of closure of a residual VSD in 17 patients, relief of a RVOT gradient in 11, insertion of a RVOT valve in 4, tricuspid valve replacement in 1 (reoperated twice), aortic valve replacement in 1, and excision of a RVOT aneurysm in 1. Two patients died in hospital (9%) but there were no early deaths in the 11 patients reoperated upon after 1978. Mean follow-up period was 135 months. There were 2 late deaths. The actuarial 20-year survival was 87%. Of the surviving patients, 16 (89%) were in New York Heart Association class I, 1 (5.5%) was in class II, and one (5.5%) was in class III. One patient required a second reoperation for tricuspid bioprosthesis degeneration and 1 patient had moderate recurrent RVOT gradient due to calcified pulmonary bioprosthesis. This study tends to support the policy of recommending reoperation in the presence of surgically significant residual defects. Reoperation is associated with a low early mortality and good long-term results.

Erupted abscess cavity and stenosed pulmonary homograft in repeated radical sternotomies: Anaesthesia and haemodynamics control

“…Due to medical advances, these patients are surviving into adulthood and their numbers have been steadily increasing. [6][7][8][9][10] The main worry during reoperation is the inherent risk of the procedure itself. The factual reported mortality rates for reoperation have been relatively high at 7.1-15.5%, [7][8][9] with the most frequent perioperative morbidity accidental cardiovascular trauma during dissection.…”

Imaging of recurrent ventricular septal defect and supravalvular pulmonary stenosis eight years after assumed total surgical repair of tetralogy of Fallot

“…It is not inconceivable that our patient was protected against pulmonary hypertension because of the supravalvular ridge. Pom~ et al [5] recommend that every symptomatic or asymptomatic patient who presents with evidence of a residual VSD should undergo restudy. Insertion of an aortic homograft in the PT was considered necessary for prevention of pulmonary regurgitation, since pulmonary regurgitation may be partly responsible for abnormal RV hemodynamics in tetralogy of Fallot patients.…”

Thoughts about fixed subaortic stenosis in man and dog

“…82 Although rare, fixed subaortic stenosis has also bee seen following repair of tetralogy of Fallot. [175][176][177][178][179] Surgical intervention for the long-segment and diffuse forms of stenosis have proved much more problematic. The type of surgical procedures discussed for the fibrous shelf only rarely relieve the pressure gradient, and most patients were left with residual and important obstruction, as well as the substrate for continued damage to the aortic valve.…”