Tof repair using monocusp reconstruction with a tap. Introduction in patients with tetralogy of fallot tof, use of transannular patch tap may be required in order to relieve significant right ventricular. A retrospective analysis of 122 pts who had undergone tof repair with or without tape was performed. Tetralogy of fallot tof is the third most common congenital heart defect and the most common form of congenital heart disease to cause cyanosis.
The initial efforts at repair focused on the complete relief of obstruction across the right ventricular outflow tract rvot, usually including an aggressive resection of right ventricular muscle bundles and incorporating a large transannular patch. The goal of surgery is to repair the four defects of tetralogy of fallot so the heart can work as normally as possible. Some patients may require earlier correction in the setting of severe cyanosis. Right ventricular rv volume overload increases morbidity and mortality after tetralogy of fallot tof repair. Pulmonary valve pv incompetence following transannular patch tap repair of tetralogy of fallot tof results in longterm morbidity and mortality. In patients with tetralogy of fallot tof, use of transannular patch tap may be required in order to relieve significant right ventricular outflow tract obstruction, subsequently resulting in pulmonary insufficiency pi. The aim of this study was to detect ventricular arrhythmia incidence and to find out the relationship between ventricular arrhythmia and the transannular and infundibular patch repair techniques. A novel predictive value for the transannular patch. The overall outcome after surgical repair of tetralogy of fallot tof.
Our objective is to evaluate early and midterm results of pulmonary leaflets sparing with infundibular preservation and tricuspid. Mar 29, 2019 unedited hd video of tetralogy of fallot repair with a limited transannular patch and transatrial vsd closure in a 5 moth old child. Reoperations are no more frequent that with the use of transannular patches. Total repair of tetralogy of fallot radiology reference. Repairing the defects can greatly improve a childs health and quality of life. Ventricular arrhythmia and tetralogy of fallot repair with transannular patch article pdf available in anadolu kardiyoloji dergisi. Monocusp valve placement in children with tetralogy of. The narrowing in the pulmonary valve is also repaired with the transannular patch to improve blood flow to the lungs. These problems are treated with medicines, procedures, and surgery. A novel predictive value for the transannular patch enlargement in. Elective primary repair of acyanotic tetralogy of fallot in. Numbers above curves show the number of patients alive after 25 years of the followup in the 1970s and the 1980s.
The original repair consisted of ventricular septal defect vsd closure through a large right ventriculotomy and right ventricular. Surgical strategies like pulmonary leaflets sparing and tricuspid valve repair at time of primary repair may decrease rv overload. Surgical results of monocusp implantation with transannular patch angioplasty in tetralogy of fallot repair. Need of transannular patch in tetralogy of fallot surgery carries a. Tetralogy of fallot tof with pulmonary stenosis is the common form of tetralogy of fallot, and it is the focus of this article. Initial results using a transannular patch with a modified monocusp valve to repair the outflow tract in the tetralogy of fallot were promising. Unedited hd video of tetralogy of fallot repair with a limited transannular patch and transatrial vsd closure in a 5 moth old child. If a patch is inserted, it may be used to widen the pulmonary artery from the valve upward. Tetralogy of fallot with pulmonary stenosis treatment. A patch across the pulmonary valve annulus a transannular patch is often required in order to adequately relieve right ventricular outflow tract obstruction. Residual risk after tetralogy of fallot repair congenital.
In tof patients etiology for right ventricular restrictive physiology are associated with lower sp0 2, transannular patch repair, longer cpb and longer aortic cross clamping time, hypertrophy, lower tapse, lower pasp and lower tapsepasp ratio. Valvesparing options in tetralogy of fallot surgery operative. Background early primary repair of tof normalizes intracardiac flow patterns, which may allow subsequent normal rvot. The most common surgical procedures for tof repair include infundibulectomy, transannular pulmonary artery patch repair, and right ventriclepulmonary artery conduit. Initially, patients typically underwent complete repair after 12 months, often after placement of a palliative shunt allowed somatic growth in small infants who developed cyanosis at an early age. Eventfree survival event reoperation or death after tof repair with or without a transannular patch tap or no tap. Jun 29, 20 tetralogy of fallot tof is one of the most common congenital heart diseases for which patients are referred for postoperative magnetic resonance mr imaging evaluation.
Valvesparing surgery for tetralogy of fallot procedure details. We sought to determine whether a repair that increases the pv. 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. Teenagers and adults who had surgery to repair tetralogy of fallot may have longterm heart problems, such as heart function problems, arrhythmias irregular heartbeats, or problems resulting from the original repair. The problems related with primary repair for tetralogy of. Transannular patch was used in 20 50% patients, and pulmonary valve annulus could be preserved at the primary repair in 20 patients. When a transannular patch is used in the primary repair, the twostage approach is projected to be. Transannular patch tap repair of tetralogy of fallot tof is correlated to poor late outcome, 30% need reoperation due to pulmonary regurgitation pr. Severe pulmonary regurgitation in adolescents with. Although recent literature has focused on the deleterious effects of.
Use of a pulmonary neovalve with a transannular patch for repair. The most common surgical procedures for tof repair include infundibulectomy, transannular pulmonary artery patch repair, and right ventriclepulmonary artery conduit placement. In our initial study of this technique, beginning in november 2001, 43 patients with tof and 2 patients with isolated pulmonary valve stenosis had relief of rvoto with either a transannular patch plus pulmonary valve cusp augmentation n 18 or a transannular patch alone n 25. Transannular patch of the pulmonary artery simulation on a. Tetralogy of fallot tof is one of the most common congenital heart diseases for which patients are referred for postoperative magnetic resonance mr imaging evaluation. As a result, i got hold of the most interesting ecg i have recorded to date. Repair of tetralogy of fallot in neonates and young. Effect of transannular patching on outcome after repair of.
Severe stenosis at both pulmonary annulus and the right ventricle outflow impose the tap. Learn congenital heart defect treatment, symptoms, repair, causes, outcomes and more. Monocusp valve placement in children with tetralogy of fallot. Between march 2000 and march 2009, 36 patients with a tof received a tap. If the narrowing is limited to the supravalvar area, a patch can be placed across the narrowing on the main pulmonary artery. Recent evidence indicates, however, that use of a transannular patch can.
Pulmonary stenosis congenital heart disease cove point. They finally concluded that rvot reconstruction in tof, using only a limited transannular incision and a stiff dacron patch, that restricts the. Tetralogy of fallot is a conotruncal defect resulting from anterior malalignment of the infundibular septum. Surgical results of monocusp implantation with transannular. Our study is a populationbased evaluation of the longterm results after surgical repair for tetralogy of fallot tof. Reopera tions transannular patching was not a risk factor for reopera tion in general after repair of tetralogy of fallot table 2. Monocusp valves in the transannular patch repair of. 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. Aiming to preserve pulmonary valve function in tetralogy of. 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. 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. Significant resection of right ventricular muscle, coupled with pulmonary insufficiency resulting from transannular patch repair can lead to early postoperative hemodynamic instability. At repair, cardiopulmonary bypass with aortic crossclamp was used.
In addition, the authors have provided evidence supporting the bene. The pediatric cardiologist and cardiac surgeon will decide the best time to do the surgery. Through this incision, the ventricular septal defect is closed with a patch, and another patch is placed to enlarge the outer surface of the pulmonary outflow from the right ventricular outflow tract, across the. Opinions differ regarding the timing of surgeryincluding the need for a palliative systemictopulmonary artery shunt prior to. The transannular patch tap technique allowed primary repair to be performed at younger ages and in patients with smaller body sizes. N in legend is the number of patients operated during the era in each group. Transannular patch repair uses an incision from the right ventricle across the pulmonary valve into the main pulmonary artery. Etiology of right ventricular restrictive physiology early. Tetralogy of fallot is most often diagnosed in the first few weeks of life due to either a loud murmur or cyanosis. Tof repair with limited transaanular patch osman alradi. We sought to determine whether a repair that increases the pv annulus and augments. Valvesparing options in tetralogy of fallot surgery emile bacha. Valvesparing surgery for tetralogy of fallot procedure.
The authors determined the need for transannular patch enlargement tape in management of tof by measuring the ratio between pulmonary annulus size to aortic valve annulus size ga ratio. In addition, the authors have provided evidence supporting the benefits for tof repair during infancy. Introduction in patients with tetralogy of fallot tof, use of transannular patch tap may be required in order to relieve significant right ventricular outflow tract obstruction, subsequently res. Pulmonary valve replacement in adult congenital cardiac. The asd was closed using the patch of autologous pericardium. We highlight our retrospective analysis for the last 10 years. This patch covers part of the wall of the right ventricle as well as widening the pulmonary artery and pulmonary valve. The use of a tap was static over the study period and was necessary in nearly 50% of cases. If the predicted prvjlv is higher than the acceptable value selected by the surgeon, a transannular patch is constructed. A patch across the pulmonary valve annulus a transannular patch is often required in order to adequately relieve. Background early primary repair of tof normalizes intracardiac flow patterns, which may allow subsequent normal rvot growth. Use of a pulmonary neovalve with a transannular patch for. In our institution, we showed a 100% survival rate at 10 years from the initial correction of tetralogy of fallot with transannular patch, which suggests that primary repair with transannular patch can be undertaken safely and effectively. Prior to correction three patients had received a palliative shunt.
Enlargement of the outflow tract is a basic concept in the surgical correction of heart disease with right ventricular obstruction, such as tetralogy of fallot tof. Ga ratios were smaller in patients undergoing tape. Most patients with tetralogy of fallot tof undergo elective surgical repair between 3 and 6 months of age 15. Background tof is a rare congential defect affecting the heart, that results. Elective primary repair of acyanotic tetralogy of fallot.
The monocusp valve has been used to temporarily reduce insufficiency in hopes to improve short and midterm outcomes. However, if there is also a need to widen the outflow tract of the right ventricle, a transannular patch may be required. Although recent literature has focused on the deleterious effects of pulmonary regurgitation, inadequate relief of stenosis may increase postoperative mortality and the reintervention rate. Objectives we sought to determine if early primary repair of acyanotic tetralogy of fallot tof can be performed safely with low requirement for transannular patching tap and thereafter allow normal right ventricular outflow tract rvot growth. Recent evidence indicates, however, that use of a transannular patch can cause pulmonary insufficiency, or weakness in the pulmonary valve that allows backflow of blood into the right ventricle. A tap with monocusp reconstruction group i was used in 25 patients and a tap without monocusp.
Treatment of fallot tetralogy with a transannular patch. Following adequate rewarming, the patient is weaned from cardiopulmonary bypass. Jan 17, 2017 3d lifeprints, with alder hey surgeon rafael guerrero and giuseppe pelella, simulate the process of applying a transannular patch to the pulmonary artery of a 3d printed silicon model supplied by. The total predicted post repair pa,, without a transannular patch is the sum of the predicted prv,lv in figs 1 and 3. Our objective is to evaluate early and midterm results of pulmonary leaflets sparing with infundibular preservation and tricuspid valve repair in. Monocusp valve placement in children with tetralogy of fallot undergoing repair with transannular patch. Pdf ventricular arrhythmia and tetralogy of fallot repair. However, few reports have assessed the longterm surgical outcomes of this procedure. Cardiovascular mr imaging after surgical correction of.
Despite the limitations of our study, the augmentation of the pulmonary valve cusp with autologous pericardium is simple, does not significantly prolong the operation, reduces the degree of pi in the immediate postoperative period, and improves the early outcome after tatp tof repair requiring a transannular patch. I then proceeded to open the right atrium through which i was able to identify a large atrial septal defect. Transesophageal echocardiography is utilized to help assess adequacy of repair. What is surprising, however, is both the relative consistency and outcomes following the use of a transannular patch tap. Transannular patching is used to relieve significant pulmonary annular stenosis during tetralogy of fallot repair. Transannular patch of the pulmonary artery simulation on a 3d. The ventricular septal defect was closed through a right ventriculotomy in 96. Repair of tof is usually done between 39 months of age. Repair of tetralogy of fallot in neonates and young infants. Correction with transannular patch was performed in 80%, as reported by seddio et al. A total of 600 patients underwent surgical repair of tof before the age of 15 years during the 46year period from 1962 to 2007. The incidence of tetralogy of fallot tof among patients with atrioventricular septal defect avsd is estimated to be about 6% to 10%. Finally, the rvot patch itself can act as an energy sink, especially when large and patulous.
Oct 18, 2016 pulmonary valve replacement in adult congenital cardiac surgery. The pulmonary valvesparing approach to repairing tetralogy of fallot can be performed successfully in as many as 80% of the patients in which its attempted. From 1974 to 1993, 103 infant repairs were performed with a mean age at repair of 6. The use of circulatory arrest was reduced in later years as the advantages of lowflow cardiopulmonary bypass became apparent. A functioning pulmonary valve does not improve immediate postsurgical outcomes. B survival after repair of tetralogy of fallot with or without a transannular patch tap or no tap in different decades. Post repair for tof in general current surgical survival, even for symptomatic infants repair of tetralogy of fallot. Jan 22, 2018 right ventricular rv volume overload increases morbidity and mortality after tetralogy of fallot tof repair. Need of transannular patch in tetralogy of fallot surgery. All procedures were complete conections and only 3 patients had undergone previous shunt operations. The 2011 sts report gives a mean length of stay for tof repair with ventriculotomy and transannular patch of 11. 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. Pdf ventricular arrhythmia and tetralogy of fallot. Aiming to preserve pulmonary valve function in tetralogy.
Valvesparing options in tetralogy of fallot surgery. Monocusp reconstruction with a transannular patch tap results in early improvement because it relieves residual volume hypertension during the immediate postoperative period. Valvesparing repairs have recently gained recognition. They finally concluded that rvot reconstruction in tof, using only a limited transannular incision and a stiff dacron patch, that restricts the pulmonary annulus. Read monocusp valves in the transannular patch repair of tetralogy of fallot.
The association of tetralogy of fallot tof with complete atrioventricular septal defect cavsd is rare1,2. Numbers above the curves show the number of living patients 25 and 43 years after corrective operation. The initial efforts at repair focused on the complete relief of obstruction across the right ventricular outflow tract rvot. Then, a more permanent repair that preserves pulmonary valve function can be. Transannular patching clearly was a risk factor for reop eration for pulmonary regurgitation fig 3. The transannular patch technique was used to relieve the. Regurgitation was mild in 19 cases and moderate in 2 the first and second in the series. The total predicted postrepair pa,, without a transannular patch is the sum of the predicted prv,lv in figs 1 and 3. Relief of rvot obstruction can be achieved by means of pulmonary valvotomy.