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J Thorac Cardiovasc Surg 1998;115:351-360
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Conotruncal Repair For Tetralogy Of Fallot: Midterm Results

Sponsor:

Edward L. Bove, MD

From the Department of Cardiovascular Surgery, Jikei University, Tokyo, Japan,^a Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,^b Department of Pediatrics, Imperial College School of Medicine at the National Heart & Lung Institute, Royal Brompton Hospital, London, United Kingdom,^c and the University of Michigan, Ann Arbor, Mich.

Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington D.C., May 4-7, 1997.

Received for publication May 6, 1997; revisions requested June 10, 1997; revisions received Sept. 5, 1997; accepted for publication Sept. 8, 1997. Address for reprints: Hiromi Kurosawa, MD, Department of Cardiovascular Surgery, Jikei University, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105, Japan.

Objective: Because of the left-sided location of the main atrioventricular conduction axis, the membranous flap can be safely used for closure of the ventricular septal defect in tetralogy of Fallot.

Methods: Conotruncal repair consists of (1) precise closure of the defect using the membranous flap and (2) outflow reconstruction of the right ventricle by a wide monocusp patch. This method has been followed in 233 patients from October 1985 to March 1997. The age of patients ranged from 2 months to 53 years, with a mean of 4.6 years; 44% were younger than 2 years of age, and 11% were less than 12 months of age.

Results: A membranous flap was present in 86%, 12% had a muscle bar between the defect and the tricuspid valve, and only 2% had neither a membranous flap nor a muscle bar. There was no early death; two late deaths occurred over a mean follow-up period of 7.3 years. The actuarial survival was 99.1%. No patients required reoperation except for two with residual anomalously connecting pulmonary veins. All 233 patients were in sinus rhythm postoperatively. No patient has had a significant residual defect. The mobility of the polytetrafluoroethylene monocusp was echocardiographically detected in 85% and pulmonary regurgitation was less than mild in 82% at the late phase. The late right and left ventricular pressure ratio was 0.40 ± 0.14 (n = 30) and the late central venous pressure was 5.6 ± 2.2 mm Hg (n = 30).

Conclusion: Conotruncal repair has provided good midterm results with a low central venous pressure, well-reconstructed outflow tract of the right ventricle, no residual defect, and no heart block.

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