Transatrial Repair of Tetralogy of Fallot

Despite satisfactory hemodynamic results with the classical correction of tetralogy of Fallot by right ventriculotomy approach, the undesired effects of ventriculotomy incision such as sudden death due to ventricular arrhythmias and right ventricular dysfunction may appear in the Iate postoperative period. In cases without infundibular hypoplasia, a correction with limited or no ventriculotomy by transatrial approach might preclude these Iate occurring complications. Between January 1987 and July 1996, a total of 92 patients with tetralogy of Fallot without annular and infundibular hypoplasia were totally corrected with transatrial approach in our Institute. Ventricular septal defect closure and infundibular resection were achieved through tricuspid valve in all patients with a mean age of 5.6 ± 3.22 years. Valvotomy was done with the same approach in 57 patients with pulmonary valve stenosis. After weaning from cardiopulmonary bypass, a right ventricular to left ventricular pressure ratio below 0.8 was accepted as a sufficient enlargement for right ventricular outflow tract reconstruction. In 56 patients the pressure ratio was found under 0.8 (mean 0.58 ± 0.21 ). In 36 patients with pressure ratio ranging among 0.8 and 1.14, cardiopulmonary bypass was reconstituted and a limited ventriculotomy followed by an enlargement of right ventricular outflow tract with a pericardial patch was applied. The pressure ratios were measured between 0.45-0.76 (mean 0.62 ± 0.16) after patch application. Two patients from low cardiac output, one patient with sepsis and one patient from bleeding were lost in the early postoperative period (4.4 %). There was no mortality in 72 (82 %) patients who were followed for a mean of 59.2 ± 33.9 months. One patient was reoperated because of recurrent VSD on the 6th postoperative month. In echocardiographic examinations, flow rate through the pulmonary valve that was measured 1.29 - 2.24 m/sec, the gradient of right ventricular outflow tract varied between 5 and 22 mmHg. All these patients were asymptomatic and receiving no medication. Hence, in patients with tetralogy of Fallot without annular and infundibular hypoplasia, hemodynamic results from transatrial correction are effective and reliable, in addition to avoiding serious complications seen with the extensive ventriculotomy incision in the Iate postoperative period