Surgical Management of Complete Atrioventricular Septal Defect with Tetralogy of Fallot

Abstract

IntroductionThe association of complete atrioventricular septal defect (CAVSD) with tetralogy of Fallot (TOF) was known as a kind of rare congenital cardiac anomaly, first described by Bull 1) in 1885. In 1969, D'Allaines 2) mentioned the surgical management of this heart malfor mation for the first time. During the few past decades, the occurrence of CAVSD with TOF remained relatively infrequent, presenting in 5%-10% children with CAVSD and in 1.7% of patients with TOF. 3,4) Nevertheless, mor tality for complete surgical repair has decreased tremen dously from 29%-40% in 1990 [3][4][5][6] to 0%-20% in recent years. [7][8][9][10][11][12][13][14][15] We retrospectively reviewed 17 patients with this combination of lesions in our hospital for determi ning the best treatment for CAVSD with TOF and to assess our surgical approach with regard to preoperative evaluation, time of complete correction, number of patches used to septate the heart and reconstruction of right ventricular outflow tract (RVOT). Materials and Methods

Cardiac Function After Tetralogy of Fallot/Complete Atrioventricular Canal Repair

“…Our perioperative mortality of 0% compares favorably to reported mortalities of 0% to 31%. 4,[6][7][8][9][10][11][12][13][14] Similarly, our 0% late mortality is consistent with certain small series that have also reported no late mortalities, 4,10 though other series have reported up to 6% to 14% late mortality over approximately five years of follow-up. 6,11,12 In two series of longer durations, Table 3.…”

Repair of complete atrioventricular septal defect with tetralogy of Fallot

“…CAVSD associated with TOF (CAVSD-TOF) affects the septa of both atria and ventricles and both ventricular inlets and outlets. Initial experiences of surgical correction for this lesion were associated with high mortality (2)(3)(4), however recent reports have demonstrated acceptable outcome (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Controversy still exists about the surgical approach, this related to the number of patches employed for CAVSD correction, the use of a right ventriculotomy, cleft closure and RVOT reconstruction, employment of a transannular patch, previous palliative procedures etc (15,16).…”