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Shiv Kumar Choudhary
Sachin Talwar
Jayesh Dhareshwar
Panangipalli Venugopal
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Ann Thorac Surg 2006;82:1316-1321
© 2006 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Total Transatrial Correction of Tetralogy of Fallot: No Outflow Patch Technique

Balram Airan, MCh*, Shiv Kumar Choudhary, MCh, Honnakere Venkataiya Jayanth Kumar, MS, Sachin Talwar, MCh, Jayesh Dhareshwar, MCh, Rajnish Juneja, DM, Shyam Sunder Kothari, DM, Anita Saxena, DM, Panangipalli Venugopal, MCh

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India

Accepted for publication March 31, 2006.

* Address correspondence to Dr Airan, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India (Email: iactscon_2004{at}yahoo.co.in).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: The aim of this study was to analyze the feasibility and early results of transatrial total correction of tetralogy of Fallot (TOF).

METHODS: Of the 860 patients undergoing total correction for TOF between January 2000 and July 2005, 334 patients were considered morphologically suitable for transatrial total correction. The ventricular septal defect (VSD) closure, infundibular resection, and pulmonary valvotomy were performed through the right atrium without a right ventriculotomy. Age ranged from 6 months to 40 years (median, 2.8 years), and weight ranged from 5.5 to 70 kg (median, 14 kg).

RESULTS: Peroperatively, 34 patients required right ventriculotomy and transannular patch; hence, they were excluded from the study. In addition, pulmonary arteriotomy was required in 71 patients (22.9%). There were 4 hospital deaths. There were 4 early reoperations (residual/additional VSD in 3 and tricuspid regurgitation in 1). Two patients had complete heart block requiring permanent pacemaker. Echocardiography at discharge showed a peak right ventricular outflow tract gradient of 20 ± 5.2 mm Hg. Mean follow-up was 26.8 ± 4.2 months (range, 1 to 52 months). The right ventricular outflow tract gradients reduced to 13 ± 4.2 mm Hg after a mean interval of 18.8 ± 5.2 months. Follow-up New York Heart Association class was I in 240 cases (82%), II in 49 (16%), and III in 7 (2%). There were no late deaths or reoperations.

CONCLUSIONS: Transatrial total correction of TOF can be accomplished in selected patients with good early results. In 300 cases (90%), the feasibility of transatrial total correction could be predicted accurately.




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