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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 396-402, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GD Touati, PR Vouhe, A Amodeo, P Pouard, P Mauriat, F Leca and JY Neveux
From June 1983 to April 1988, 100 consecutive infants with symptomatic
tetralogy of Fallot (without pulmonary atresia) were operated on. Ages
ranged from 0.5 to 12 months (mean 7.3 +/- 3.7). Twenty patients were 0.5
to 3 months, 21 were 3 to 6 months, and 59 were 6 to 12 months of age. Mean
weight was 6.5 kg +/- 1.7. Seventy patients received a transannular patch.
The hospital mortality rate was 3% and there were no late deaths.
Cumulative follow-up was 180 patient-years. Causes of death included
hypoplastic pulmonary arteries (4 and 5 months old) and right ventricular
failure (4 months old). The most important factors influencing right
ventricular outflow tract reconstruction were neither weight (p = 0.90) nor
age (p = 0.05) but rather were the ratio between weight and pulmonary
arterial outflow tract diameter (p = 0.0005) and the ratio between body
surface area and pulmonary arterial outflow tract diameter (p less than
0.0001). The last 48 patients were operated on with no deaths. During this
period, operative management differed essentially in myocardial protection
with blood cardioplegia. The predicted 30-day survivorship after repair was
90% to 99% (95% confidence limits). No ventricular arrhythmias have been
detected after repair (mean follow-up 22.2 months). Mean right
ventricular/left ventricular end-diastolic dimension ratio was (0.53 +/-
0.10 with M- mode echocardiography. These early results encourage us to
proceed with primary repair of infants with symptomatic tetralogy of Fallot
thanks to improved surgical management and enhanced myocardial protection.
ARTICLES
Primary repair of tetralogy of Fallot in infancy
Department of Cardiovascular Surgery, University Hospital Laennec, Paris, France.
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