Tetralogy of Fallot: complete surgical repair under one year of age

Abstract

Objective The purpose of this study was to evaluate the outcome following complete repair of tetralogy of Fallot(TOF)under one year of age. Methods 58 infants with TOF undergoing were completely repaired between January 1999 and August 2005 were reviewed. The concomitant lesion included atrial septal defect in 8 patients, patent ductus arteriosus in 3 patients and abnormal coronary arteries in 3 patients, Down's syndrome in 2 patients. 2 patients had a previous modified B-T shunt. The site of ventricular septal defect(VSD)was perimembranous in 56 patients and subarterial in 2. 2 patients had VSD repair with fenestration. Correction was accomplished through ventriculotomy(48 patients), atriotomy(4 patients)or transatrial-transventricular approach(6 patients). A transannular patch was inserted in 39 patients. Results The mean bypass and aortic cross-clamp time were 95. 5 and 53. 5 minutes respectively. The mean ventilation time, ICU stay and postoperative hospital stay were 30 hours, 4 days and 14 days respectively. Delayed sternum closure was performed in 3 patients. There were 2 early deaths(mortality 3. 4%)and no late death. Early postoperative complication included low cardiac output(5 patients), renal failure(4 patients), supraventricular, junctional ectopic tachycardia(2 patients), complete heart block(1 patient), etc. Follow-up was available from 3 months to 5 years postoperatively. All the patients alive were doing well with NYHA functional class I to Ⅱ . Conclusions Early complete repair of TOF in infancy is associated with acceptable mortality and morbidity, as well as excellent heart function during early and mid-term follow-up. Elective complete repair of TOF under one year of age is recommended. Key words: tetralogy of Fallot; Infancy; Surgery