Total Correction of Tetralogy of Fallot in Adolescents and Adults

Abstract

Sixty-four cyanotic patients over 15 years of age with tetralogy of Fallot have undergone total correction. Fifty-one patients had previous shunting procedures. The established intracardiac technique for total repair was used throughout. In 11% (7 of 64) of patients reconstruction of the pulmonary outflow tract was required. Follow-up extends from six months to ten years. Operative mortality was 6.25% (4 of 64). There was one late death. All deaths were technically related and none could be correlated with patient age. Bilaterally functioning Blalock shunts and Potts anastomoses contributed significantly to operative mortality. Abundant collateral circulation exists in older patients with tetralogy of Fallot, and increased bleeding in this series was reflected in a 20.3% (13 of 64) reoperation rate. Survivors represent 92.2% (59 of 64) of the group and all are completely asymptomatic. Approximately one-half of the surviving patients have undergone postoperative catheterization. Of those patients studied, 93.4% (29 of 31) have a good to excellent hemodynamic result following correction. All patients with outflow-tract patches subsequently developed pulmonary insufficiency and right-heart failure. These patients were easily managed on a cardiotonic regimen, however, and digitalis was discontinued in each case by the end of the third postoperative month. These mortality and survivor figures parallel those obtained in our total experience of 250 tetralogy repairs. We believe all patients with tetralogy of Fallot should undergo total correction. Advanced age is no contraindication to surgery. Shunting procedures, when indicated, are to be considered only a preliminary to full correction.

Adults with congenital heart disease undergoing first surgery: prevalence and outcomes at a tertiary hospital

“…Work on the treatment of tetralogy of Fallot demonstrated, even in our country, the majority of patients are treated in adulthood presents good performance and favorable anatomy diseases [7,8]. However, in our series, the four patients operated on in two there was a need for transannular enlargement, increasing the proportion of patients with unfavorable anatomy, which may be due to the small number of patients in this analysis.…”

Tetralogy of Fallot in teenagers and adults: surgical experience and follow-up

“…6,7,15,16 In our experience, the operative mortality was 10%, with most of the deaths occurring during the initial experience. This is in contrast to the 1% mortality rate seen in the pediatric age group recently reported from our institution.…”

Tetralogy of fallot in the elderly

“…In general, surgical correction in the adult, when indicated, can be undertaken with a risk similar to that in children, and clinical improvement can be expected (Bahnson et al, 1962;Beach et al, 1971;Bjemulf and Cullhed, 1968;Kirklin et al, 1959). A unique problem seen in the adult is that of postoperative bleeding.…”

“…A unique problem seen in the adult is that of postoperative bleeding. This is due to the well-developed collateral circulation (Beach et al, 1971). The risk of bleeding is further increased if the patient had had a previous palliative procedure.…”