Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair

Abstract

Tetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle-to-pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention.

Repair of complete atrioventricular septal defect with tetralogy of Fallot

“…Some authors have advocated the avoidance of a transannular incision preferring a valve conduit over a transannular patch (25) others have not found a transannular patch to be detrimental to short or long-term results (19). If a transannular patch is employed a complete relief of RVOTO would appear to be essential (13). However, as in patients with simple TOF, right ventricular dilatation due to pulmonary valve insufficiency may develop in patients with a transannular patch, requiring pulmonary valve replacement with a valved homograft.…”

“…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).…”

Surgical Management of Complete Atrioventricular Septal Defect with Tetralogy of Fallot

“…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). …”

Defeito do septo atrioventricular associado à tetralogia de Fallot em paciente com síndrome de Down

“…The corrective surgical procedure demanded caution regarding the possibility of atrium-ventricular valve insufficiency and residual shunts, ill-prognostic factors and with higher possibility for the need of reoperation [2,3]. OPERATION Sternotomy, heparine administration, insertion of cannulas in the aorta and vena cava, extracorporeal circulation aid (ECC) with hypothermia at 26ºC.…”

“…Followed-up in the medical office two months ago, she is presently acyanotic, not complaining about fatigue, with echocardiogram showing moderate to important pulmonary valvar insufficiency, which is due to the treatment applied in the right ventricle outlet, only using the implantation of bovine pericardium patch without valve or valved tube [2].…”