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Ann Thorac Surg 1990;49:775-779
© 1990 The Society of Thoracic Surgeons

Articles

Palliative reconstruction of right ventricular outflow tract in tetralogy with hypoplastic pulmonary arteries

Yutaka Okita, MD*, Shigehito Miki, MD, Kenji Kusuhara, MD, Yuichi Ueda, MD, Takafumi Tahata, MD, Kazuo Yamanaka, MD, Tokio Tamura, MD

Department of Cardiovascular Surgery and Pediatric Cardiology, Tenri Hospital, Tenri, Nara, Japan

Accepted for publication December 29, 1989.

* Address reprint requests to Dr Okita, Department of Cardiovascular Surgery, Tenri Hospital, 200 Mishima, Tenri, Nara, Japan 632.

Twenty-five symptomatic patients with tetralogy of Fallot underwent palliative reconstruction of the right ventricular outflow tract without closure of the ventricular septal defect. Their ages ranged from 5 months to 20 years (mean age, 3.5 yean). Eight patients had had 13 prior systemic-pulmonary arterial shunts. There were six hospital deaths (24%). Three patients needed a repeat right ventricular outflow reconstruction. There was one late death. The other patients manifested clinical improvement; hematocrit decreased from 0.54 to 0.43 (p < 0.01) and arterial oxygen saturation increased from 63.0% to 83.2% (p < 0.01). The size of the pulmonary artery, defined as the ratio of the sum of the diameter of the right and left pulmonary arteries to the diameter of the descending aorta, increased from 0.72 to 2.06 (p < 0.01). Sixteen patients underwent a corrective operation 2.4 yean after palliation. The results of palliative right ventricular outflow tract reconstruction suggest that it may be an optional strategy for the treatment of symptomatic patients who have tetralogy of Fallot with severely hypoplastic pulmonary arteries.




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