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Ann Thorac Surg 1988;45:7-10
© 1988 The Society of Thoracic Surgeons

Articles

The Relief of Pulmonary Stenosis by a Transatrial versus a Transventricular Approach to the Repair of Tetralogy of Fallot

John G. Coles, M.D.*, John W. Kirklin, M.D.*, Albert D. Pacifico, M.D., James K. Kirklin, M.D., Eugene H. Blackstone, M.D.

From the Division of Cardiothoracic Surgery, the Department of Surgery, the University of Alabama at Birmingham School of Medicine and Medical Center, and the Alabama Congenital Heart Disease Diagnosis and Treatment Center, Birmingham, AL

Accepted for publication June 10, 1987.

* Address reprint requests to Dr. John Kirklin, Department of Surgery, Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, University Station, Birmingham, AL 35294

The ratio of peak pressure in the right ventricle to that in the left ventricle (PRV/LV) in the operating room thirty minutes after repair of tetralogy of Fallot by an atrial approach, with or without a concomitant transatrial approach, was 0.58 ± 0.217. It was 0.52 ± 0.158 when repair was through a right ventricular approach (p for difference = 0.16). This ratio 18 to 24 hours postoperatively was 0.49 ± 0.148 and 0.45 ± 0.121 for the right atrial and right ventricular approaches, respectively. The reduction in PRV/LV between the two observations was –0.09 ± 0.147 for the right atrial and –0.07 ± 0.110 for the right ventricular approach (p for difference = 0.4). Therefore, the predictive rules for placing a transannular patch, rules derived from patients in whom the right ventricular approach was used and depending in part on the fall in PRV/LV during the first 24 hours after operation, are also applicable to patients in whom an atrial approach, with or without a transpulmonary approach, is used.




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