Treatment of fallot tetralogy with a transannular patch. Further, the need of a transannular patch was associated with a higher risk of reoperation, but had no impact on late survival. Need of transannular patch in tetralogy of fallot surgery carries a higher. Tetralogy of fallot the patient guide to heart, lung. Backgroundin tetralogy of fallot, transannular patching is. Transannular patching was used in 99 patients 52%, patch closure of a right ventriculotomy in 35. The association of tetralogy of fallot tof with complete atrioventricular septal defect cavsd is rare1, 2. Pdf need of transannular patch in tetralogy of fallot. One is to close the ventricular septal defect so that theres no mixing between the two pumping chambers, and the second is to relieve the blockage to the lungs. Nollert g, fischlein t, bouterwek s, bohmer c, klinner w, reichart b.
Type of surgical repair, use of prostaglandins and postnatal death were among the outcomes investigated. Chd longterm results after early primary repair of tetralogy of fallot. Transesophageal echocardiography is utilized to help assess adequacy of repair. The data are also relevant to the recent upsurge of interest in using semi lunar valve allografts rather than transannular patches when the pulmonary annulus is hypoplastic. Complete correction of tetralogy of fallot has good longterm results. Should patients with transannular patch repair of tetralogy. Clinical outcomes of surgical pulmonary valve replacement.
If surgeries are performed in babies, then more than 90% survive to adulthood and lead healthy lives. Ylitalo p1, nieminen h1, pitkanen om1, jokinen e1, sairanen h2. Pulmonary stenosis congenital heart disease cove point. Repair included transannular patch 61 tofps, 9 tofpa. This patch covers part of the wall of the right ventricle as well as widening the pulmonary artery and pulmonary valve. Gore, newark, del patch is then sutured to both margins of the incision, increasing the. If a patch is inserted, it may be used to widen the pulmonary artery from the valve upward. The anterior wall of the rvot is opened through the annulus of the pulmonary valve. C, d systolic thickening and inward movement of the rvot in a patient without patch repair white arrows. Outcomes of prenatally diagnosed tetralogy of fallot. Ppvi after repair of tet fallot with transannular patch. Transannular patching is a valid alternative for tetralogy of fallot and. This type of heart defect changes the normal flow of blood through the heart.
A congenital heart defect is a problem with the hearts structure thats present at birth. The transannular patch technique was used to relieve the obstruction at the level of the annulus, which lead to the wellknown, longterm problems associated with free pulmonary valve regurgitation pr, including right ventricular dilation. One is that there is a large hole in the wall of muscle septum that divides the 2 bottom pumping chambers ventricles of the heart. Right ventricular function in adults with repaired. Patients with genetic syndromes had significantly lower overall survival after repair. An analysis was performed on the clinical variables, morbidity and mortality.
Tetralogy of fallot in the current era seminars in thoracic and. Longterm survival of patients with tetralogy of fallot with or without a patch up to or through the pulmonary annulus who survived the immediate postoperative period. Tetralogy of fallot is a rare, complex heart defect that occurs in about 5 out of every 10,000 babies. Therefore, whether to repair tetralogy of fallot is not often debated. The condition causes mixing of oxygenpoor blood with the oxygenrich blood being pumped out of the heart and into the circulatory system of blood vessels. The outcome for patients with tetralogy of fallot has improved dramatically since the introduction of surgical repair.
Methods and resultsin our institution, 191 patients survived a tetralogy of fallot repair between 1964 and 1984. Tetralogy of fallot tof childrens hospital of philadelphia. The procedure completely relieved recurrent stenosis. The present study evaluated the efficacy of reoperation following complete correction of tetralogy of fallot, the sites of recurrences and impact of techniques used at first operation. The cause of most congenital heart defects is unknown. From 1958 to 1977, 658 patients underwent correction of tof at our institution and were analyzed for survival. The prognosis of patients with unrepaired tetralogy of fallot tof is inferior to the life expectancy of those undergoing repair. Four patients had previously undergone palliative treatment with a ptfe. Primary repair of fallot tetralogy has been performed successfully for the last 45. Tetralogy of fallot tof is a congenital heart defect. Tetralogy of fallot is most often diagnosed in the first few weeks of life due to either a loud murmur or cyanosis. Repair of tetralogy of fallot in neonates and young infants. Babies with tetralogy of fallot usually have a patent ductus arteriosus at birth that provides additional blood flow to the lungs, so severe cyanosis is rare early after birth.
The problems related with primary repair for tetralogy of fallot, especially about transannular patch repair since the initial surgical correction of tetralogy of fallot tof in 1954, advances in management have helped reduce early surgical mortality to less than 2% 1. Among 814 patients undergoing repair of tetralogy of fallot with pulmonary stenosis between 1967 and may 1986, transannular patching in the current era was a weak risk factor for death early. Transannular patch repair was the commonest operation among patients born after 1985 43. Comparison of pulmonary regurgitation and rv size after repair of tetralogy of fallot. The problems related with primary repair for tetralogy of. Mar 30, 2017 tetralogy of fallot with common av canal av septal defect avsd is the presence of both tetralogy of fallot and complete avsd. Pulmonary valve replacement pvr was not included as an adverse event but, rather, as an inevitable consequence of early transannular patchtype repair of tetralogy. Results of total correction of tetralogy of fallot with complete atrioventricular canal. Should patients with transannular patch repair of tetralogy of fallot have pvr by 10yo debate by pediatric and adult interventional cardiac symposium featuring jamil aboulhosn. Surgery also ensures that oxygenrich and oxygenpoor blood flow to the right places. Backgroundthe timing of repair of tetralogy of fallot tof remains controversial.
Prfree survival than those with a transannular patch 8. Significant resection of right ventricular muscle, coupled with pulmonary insufficiency resulting from transannular patch repair can lead to early postoperative hemodynamic instability. One patient required a transannular patch repair after the initial valvesparing repair. Typically in the first few months of life we will perform open heart surgery to patch the hole vsd and widen the pulmonary valve or artery. In some cases, depending on the unique needs of the patient, we will perform a temporary repair until a complete repair can be done. Recently, in a holter clinic, i dealt with an 8 year old patient who was on the road to recovery after a diagnosis of congenital defect, tetralogy of fallot. We report our experience with repair of tetralogy of fallot associated. Longterm survival in patients with repair of tetralogy of. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases 42%, infundibular patch with preservation of the pulmonary valve in 7 21%, and right ventricletopulmonary artery conduit in 11 33%. Mar 30, 2017 the prognosis of patients with unrepaired tetralogy of fallot tof is inferior to the life expectancy of those undergoing repair.
Cardiac mr imaging assessment following tetralogy of. The data indicate an increased risk of death in patients who had undergone a primary palliative procedure. Longterm survival in patients with repair of tetralogy of fallot. Most adult patients with tetralogy of fallot have been operated on, usually with an rv outflow patch and vsd closure. Surgical repair of tetralogy of fallot with complete atrioventricular canal. Tetralogy of fallot is the most common congenital heart defect. Tetralogy of fallot the patient guide to heart, lung, and. Most patients with tetralogy of fallot tof undergo elective surgical repair between 3 and 6 months of age 15. Use of a transannular patch does not reduce late survival and is associated with a lower incidence of right ventricular outflow tract obstruction.
Pdf ventricular arrhythmia and tetralogy of fallot. For patients who receive a transannular rvot patch as part of the tof repair, the. Although the prognosis for patients who have undergone surgical repair is favorable early mortality rate prognosis improved considerably over time. The most common signs and symptoms seen for a newborn with tetralogy of. Some patients may require earlier correction in the setting of severe cyanosis. In designing the most appropriate operation for children with tof, the postoperative physiology should be taken into account, both in the short and long term. Tetralogy of fallot with common av canal av septal defect avsd is the presence of both tetralogy of fallot and complete avsd. Jul 31, 2016 tetralogy of fallot recently, in a holter clinic, i dealt with an 8 year old patient who was on the road to recovery after a diagnosis of congenital defect, tetralogy of fallot. This rare lesion represents only 2% of all cases of tetralogy of fallot. Tetralogy of fallot, survival, transannular patch, late results. Transannular patching is used to relieve significant pulmonary annular stenosis during tetralogy of fallot repair.
Primary repair of tetralogy of fallot predicts a lower mortality rate and longer. Oct 18, 2016 most of these adult congenital heart disease patients underwent tetralogy of fallot repair in childhood. Should patients with transannular patch repair of tetralogy of fallot ha. Use of a pulmonary neovalve with a transannular patch for repair. Pulmonary effects on exercise testing in tetralogy of. Adverse events were prospectively defined as the above andor endocarditis, documented atrial arrhythmia andor a need for permanent pacemaker or defibrillator implantation.
It is known, however, to have longterm detrimental effects, including exercise intolerance, progressive right ventricular rv dilatation and dysfunction, ventricular and. Physical examination may be deceptive after classic tetralogy repair, with severe pulmonary valve regurgitation often present if a transannular patch was used. In some repairs, the patch may extend across the pulmonary valve annulus transannular patch, making the. Survival after repair is excellent, but data 20 years are rare. Tetralogy of fallot with pulmonary stenosis treatment. How to diminish reoperation rates after initial repair of. Longterm outcome in patients undergoing surgical repair.
Ventricular arrhythmia and tetralogy of fallot repair with transannular patch article pdf available in anadolu kardiyoloji dergisi. Tetralogy of fallot patients repaired with a transannular patch without pulmonary valve replacement were compared with age, gender, and sizematched normal controls. You may need to limit your activity if there is leftover obstruction or a pulmonary valve leak, which is common after repair. Early mortality was 3% 3 of 99, and actuarial survival rates were 94% at 1. Right ventricular function in adults with repaired tetralogy. Transannular patching for tetralogy of fallot with an. Twelve of 29 41% patients received prostaglandins at birth. Transatrialtranspulmonary repair of tof included closure. Previously a routine technique, making a large incision in the right ventricle ventriculotomy and using a large transannular patch to repair tof, have been abandoned. Tetralogy of fallot video series childrens hospital of. Tof is described as 4 abnormalities that occur together. Outcomesresolutions in most cases, tetralogy of fallot can be treated with surgery.
Ppvi after repair of tet fallot with transannular patch for 12 yo patient. Tetralogy of fallot tof, the most common congenital heart defect associated with cyanosis and pulmonary undercirculation, accounts for approximately 6%10% of all cases of congenital heart disease, 1, 2. Tetralogy of fallot tof is an important lesion for all pediatric and congenital heart surgeons. Simultaneous angiography of the coronary artery and right ventricle were useful in precisely evaluating. The blood leaving the heart has less oxygen than is needed by the organs and. In a case of tetralogy of fallot, blood flow to the lungs and the body is affected. Right ventricular outflow tract obstruction and pulmonary insufficiency occur which require reintervention. People with tetralogy of fallot are more likely to also have other congenital defects. Backgroundin tetralogy of fallot, transannular patching is suspected to be responsible for late right ventricular dilatation. Need of transannular patch in tetralogy of fallot surgery carries a higher risk of reoperation but has no impact on late survival. Transannular patching is a valid alternative for tetralogy of.
Transannular patch repair is performed when there is marked stenosis of the rvot or pulmonary annulus. Transannular patching is a valid alternative for tetralogy. Tetralogy of fallot is the most common heart defect in children. Pdf ventricular arrhythmia and tetralogy of fallot repair. Prenatally diagnosed tetralogy of fallot has a good outcome with low short and midterm morbidity and mortality following valvesparing repair or transannular patch repair in fetuses and live born infants who are otherwise normal. Cardiovascular mr imaging after surgical correction of. According to the american heart association, congenital heart defects present at birth are the most common type of birth defect. Jun 29, 20 transannular patch repair is performed when there is marked stenosis of the rvot or pulmonary annulus. Effect of transannular patching on outcome after repair of. Longterm outcome in patients undergoing surgical repair of.
A patch across the pulmonary valve annulus a transannular patch is often required in order to adequately relieve right ventricular outflow tract obstruction. Total repair of tetralogy of fallot radiology reference. A 7yearold girl underwent transannular patching under the mobilized anomalous right coronary artery across the right ventricular outflow to treat progressing infundibular stenosis 6 years after total repair of the tetralogy of fallot. Need of transannular patch in tetralogy of fallot surgery. Pulmonary effects on exercise testing in tetralogy of fallot. Some degree of right ventricular failure is nearly universal following repair of tetralogy of fallot. Pitkanen, eero jokinen, heikki sairanen, need of transannular patch in tetralogy of fallot surgery carries a higher risk of reoperation but has no impact on late survival. Surgery to repair tetralogy of fallot improves blood flow to the lungs.
Results in the tetralogy of fallot group, 24 out of 57 patients underwent primary repair with a transannular patch. When we repair tetralogy of fallot, there are two major things that we need to do. Babies with tetralogy of fallot usually have a patent ductus arteriosus at birth that provides additional blood flow to the lungs, so severe cyanosis is rare early after birth as the ductus arteriosus closes, which it typically will in the first days of life, cyanosis can. Complete surgical repair of this lesion is riskier than repair of tetralogy of fallot or avsd alone. The study included patients who had complete repair of fallot tetralogy with transannular patch from january 2000 to december 2009. Following adequate rewarming, the patient is weaned from cardiopulmonary bypass. Complete repair usually performed in the first year of life. Primary repair of tetralogy of fallot predicts a lower mortality rate and longer freedom from reoperation when compared with twostage repair. As a result, i got hold of the most interesting ecg i have recorded to date. Pulmonary valve replacement in adult congenital cardiac surgery. If tetralogy of fallot has been repaired with surgery, and theres no obstruction or leak in the pulmonary valve, you may be able to participate in normal activities without much increased risk. The longterm prognosis of surgically corrected tof patients is good and has improved with each decade since the beginning of tof surgery in finland. Transannular patch repair was associated with significantly lower reinterventionfree survival median 32. One study of survivors of the first year after surgical repair showed actuarial survival rates of 97% at 10 years, 94% at 20 years, 89% at 30 years, and 85% at 36 years.
Tetralogy tehtraloje of fallot fahlo is a congenital heart defect. Tetralogy of fallot causes, symptoms, surgery, treatment. Tetralogy of fallot is rare, but it is the most common form of cyanotic congenital heart disease. However, if there is also a need to widen the outflow tract of the right ventricle, a transannular patch may be required. Hospital, transannular patch repair was avoided whenever judged possible, resulting in a low rate of tape only editorial the problems related with primary repair for tetralogy of fallot, especially about transannular patch repair atsushi mizuno, koichiro niwa department of cardiology, st. Should patients with transannular patch repair of tetralogy of fallot have pvr by 10yo debate by pediatric and adult interventional cardiac symposium featuring jamil aboulhosn, lee benson. The timing of surgery and the initial surgical procedure performed in the patient with symptomatic tetralogy of fallot remain controversial. A pericardial or synthetic polytetrafluoroethylene goretex. Adult patients with tetralogy of fallot who undergo surgery again are usually symptom free for 1015 years, but by the time they reach their fifth decade, even these patients begin to have symptoms. Cardiac surgeons perform an open heart surgery during a childs first year to treat tetralogy of fallot. The mortality rate is high among cases with chromosomal andor extracardiac anomalies. Involves closure of the vsd and resection of the infundibular stenosis, with placement of a pericardial patch to enlarge the rvot. We sought to analyze risk factors for longterm survival up to 36 years after surgical repair of tetralogy of fallot tof.
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