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Ann Thorac Surg 1998;66:2078-2082
© 1998 The Society of Thoracic Surgeons

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Original Articles

Atrioventricular septal defect with tetralogy of fallot: results of surgical correction

^a Divisions of Cardiovascular Surgery and Cardiology, The IWK Grace Health Centre, Halifax, Nova Scotia, Canada

Accepted for publication June 15, 1998.

Address reprint requests to Dr Ross, Cardiovascular Surgery, I.W.K. Grace Health Centre, P.O. Box 3070, Halifax, Nova Scotia, Canada B3J 3G9
e-mail: (dross{at}iwkgrace.ns.ca)

Background. The outcome of surgical correction of complete atrioventricular septal defect with tetralogy of Fallot has improved in recent years. Controversy exists about the optimal approach to this complex lesion. Our experience over the past 8 years with a single technique is reviewed. The important anatomic features of this lesion are discussed in relation to our method of repair.

Methods. Between 1988 and 1996, 11 consecutive patients underwent correction of complete atrioventricular septal defect with tetralogy of Fallot. Nine patients had undergone prior palliative shunts. The two-patch technique for atrioventricular septal defect was used. The ventricular septal defect was closed through a right ventriculotomy in each case. The commissure between the superior and inferior bridging leaflets of the left portion of the common atrioventricular valve was closed in each patient. Management of the right ventricular outflow tract was individualized.

Results. There was one mortality in the early postoperative period. One patient required reoperation for closure of a dehiscent left atrioventricular valve cleft. All survivors are currently in New York Heart Association functional class I or II at follow-up ranging from 2 to 101 months.

Conclusions. Atrioventricular septal defect with tetralogy of Fallot can be corrected with low mortality using the two-patch technique and closure of the ventricular septal defect through a combined approach using a right ventriculotomy and right atriotomy. Routine closure of the commissure of the left portion of the atrioventricular valve results in a low incidence of regurgitation. A good functional result can be achieved in most patients at intermediate-term follow-up.tetralogy of Fallot, atrioventricular septal defect, repair

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