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This Article Full Text Full Text (PDF) CME: Take the activity for this article: 28 Years’ Experience With Transa... Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul H. Schoof Mark G. Hazekamp Permission Requests Citing Articles Citing Articles via HighWire Google Scholar Articles by Hoohenkerk, G. J.F. Articles by Hazekamp, M. G. PubMed Articles by Hoohenkerk, G. J.F. Articles by Hazekamp, M. G. Related Collections Congenital - cyanotic Related Article

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Original Articles: Pediatric Cardiac

28 Years' Experience With Transatrial-Transpulmonary Repair of Atrioventricular Septal Defect With Tetralogy of Fallot

^a Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
^b Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands

Accepted for publication November 9, 2007.

^_* Address correspondence to Dr Hoohenkerk, Anne de Vrieslaan 9, Amstelveen, 1187 WN, the Netherlands (Email: hoohenkerk{at}casema.nl).

Presented at the Poster Session of the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: The outcome of surgical correction of atrioventricular septal defect and tetralogy of Fallot has improved in recent years but is still reported to be associated with high mortality. Controversy exists about the need of a right ventriculotomy or a right ventricular to pulmonary artery conduit. The purpose of this study was to evaluate our results of atrioventricular septal defect and tetralogy of Fallot repair by transatrial-transpulmonary approaches.

Methods: Between 1979 and 2007, 20 consecutive patients underwent correction of atrioventricular septal defect and tetralogy of Fallot. Five patients had undergone prior palliative shunts. In all patients, a transatrial-transpulmonary approach was used and repair was accomplished without a conduit. The two-patch technique was used to correct the atrioventricular septal defect. Clinical data were obtained by retrospective review of inpatient and outpatient clinical charts.

Results: There was no in-hospital mortality and one late, noncardiac death. Six patients required eight reoperations, six for left atrioventricular valve insufficiency (repair: n = 4; replacement: n = 2), one for residual ventricular septal defect, and one for pulmonary artery branch obstruction. Follow-up was complete for all patients (median, 17 years; range, 1.5 to 28 years). All 19 survivors were in good clinical condition at last control, without medication, and in New York Heart Association class I (n = 18) or II (n = 1). Transesophageal echocardiography revealed good right ventricular function, low right ventricular outflow tract gradients (mean, 9 ± 7.4 mm Hg), and trace pulmonary valve insufficiency (n = 11).

Conclusions: Atrioventricular septal defect and tetralogy of Fallot can be repaired with low mortality by the transatrial-transpulmonary approach without the use of a conduit.

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Ann. Thorac. Surg. 2008 85: 1690. [Extract] [Full Text] [PDF]

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