Surgical treatment of tetralogy of Fallot with subarterial ventricular septal defect

Abstract

Objective To declare the unique anatomy,surgical management and prognosis of tetralogy of Fallot with subarterial ventricular septal defect (VSD). Methods From November 2002 to April 2009, 150 cases of typical tetralogy of Fallot were performed operations, 13 of which had subarterial VSD. Results Morphology and sites of right ventricular outflow obstruction in 13 cases: 2 cases isolated infundibular stenosis, 3 cases infundibular + pulmonary stenosis and 8 cases infundibular + pulmonary stenosis + valve ring stenosis. The diameter of subarterial VSD ranged from 1.5 to 3.0 cm. The proportion of aorta lying above the right ventricle varied from 30% to 50%. Twelve cases cured, one died of low cardiac output syndrome. Early postoperative mortality was 7.7% ( 1/13 ). The follow-up duration ranged from 1 month to 6 years. All cases had no cyanosis and the active ability were improved. Echo showed residual stenosis in 4 cases,residual VSD in 1 case and aortic regurgitation in 1 case. Conclusions Tetralogy of Fallot with subarterial VSD is associated with worse functional outcome. To prevent adverse outcomes, precise suturing of the distal ventricular septal patch, extensive infundibulectomy,lower threshold for transannular incision, and smaller-sized ventricular septal patch placement are warranted. Key words: Tetralogy of Fallot; Heart septal defects,ventricular; Surgical procedures,operative