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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 919-924, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AD Pacifico, ME Sand, LM Bargeron Jr and EC Colvin
Classical tetralogy of Fallot was repaired by a transatrial- transpulmonary
approach in 61 of 70 patients treated surgically on one surgical service
between July 1981 and December 1985. Their ages ranged from 2.5 months to
57 years (mean 52.9 +/- 104.2 months). The ventricular septal defect was
closed through the right atrium and tricuspid valve in 60 patients and via
the pulmonary artery in one patient with a subpulmonary defect. A pulmonary
arteriotomy was made in 38 patients to expose the stenotic pulmonary valve
for valvotomy and to begin the infundibular mobilization and resection. It
was extended through a small pulmonary anulus primarily in 15 patients and
secondarily in one, a minimal distance upon the right ventricular
infundibulum to enlarge the outflow tract to 2 standard deviations larger
than the mean normal pulmonary valve anulus diameter. There were no
hospital or late deaths or reoperations among the entire group. The mean
postrepair peak right ventricular/left ventricular pressure measured in the
operating room was 0.52 +/- 0.165 for the entire group of 61 patients which
indicates similar relief of pulmonary stenosis to that obtained by the
classical transventricular repair. At follow-up between 2.3 and 53.8 months
(mean 22.6) each patient was in New York Heart Association Class I and
without cardiac medication. Postoperative cardiac catheterization studies
performed in nine patients between 4 and 28 months after operation showed
no residual ventricular septal defects and a mean peak right/left
ventricular pressure of 0.42 +/- 0.13. This series indicates that
successful repair of tetralogy of Fallot can be accomplished in most
patients by a transatrial- transpulmonary approach, which may provide
improved right ventricular function over the long term.
ARTICLES
Transatrial-transpulmonary repair of tetralogy of Fallot
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C. Alexiou, Q. Chen, M. Galogavrou, J. Gnanapragasam, A. P. Salmon, B. R. Keeton, M. P. Haw, and J. L. Monro Repair of tetralogy of Fallot in infancy with a transventricular or a transatrial approach Eur J Cardiothorac Surg, August 1, 2002; 22(2): 174 - 183. [Abstract] [Full Text] [PDF]
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C. Alexiou, H. Mahmoud, A. Al-Khaddour, J. Gnanapragasam, A. P. Salmon, B. R. Keeton, and J. L. Monro Outcome after repair of tetralogy of Fallot in the first year of life Ann. Thorac. Surg., February 1, 2001; 71(2): 494 - 500. [Abstract] [Full Text] [PDF]
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S. Kalra, R. Sharma, S. K. Choudhary, B. Airan, A. Bhan, A. Saxena, S. S. Kothari, and P. Venugopal Right ventricular outflow tract after non-conduit repair of tetralogy of Fallot with coronary anomaly Ann. Thorac. Surg., September 1, 2000; 70(3): 723 - 726. [Abstract] [Full Text] [PDF]
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J. A. M. van Son REPAIR OF TETRALOGY OF FALLOT WITH ANOMALOUS ORIGIN OF LEFT ANTERIOR DESCENDING CORONARY ARTERY J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 561 - 562. [Full Text]
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T. R. Karl, S. Sano, S. Pornviliwan, and R. B. B. Mee Tetralogy of fallot: Favorable outcome of nonneonatal transatrial, transpulmonary repair Ann. Thorac. Surg., November 1, 1992; 54(5): 903 - 907. [Abstract] [PDF]
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C. A. Dietl, A. R. Torres, M. E. Cazzaniga, and R. G. Favaloro Right artial approach for surgical correction of tetralogy of fallot Ann. Thorac. Surg., April 1, 1989; 47(4): 546 - 552. [Abstract] [PDF]
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A. D. Pacifico, A. Ricchi, L. M. Bargeron Jr., E. C. Colvin, J. W. Kirklin, and J. K. Kirklin Corrective Repair of Complete Atrioventricular Canal Defects and Major Associated Cardiac Anomalies Ann. Thorac. Surg., December 1, 1988; 46(6): 645 - 651. [Abstract] [PDF]
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J. G. Coles, J. W. Kirklin, A. D. Pacifico, J. K. Kirklin, and E. H. Blackstone The Relief of Pulmonary Stenosis by a Transatrial versus a Transventricular Approach to the Repair of Tetralogy of Fallot Ann. Thorac. Surg., January 1, 1988; 45(1): 7 - 10. [Abstract] [PDF]
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