Correction Of Tetralogy Research Articles

主題I-B-2 Fallot四徴症根治手術の問題点

主題I-B-2 Fallot四徴症根治手術の問題点

主題I-A-7 Fallot四徴症根治手術における3つの問題点

主題I-A-7 Fallot四徴症根治手術における3つの問題点

主題I-B-4 乳幼児(2才未満)Fallot四徴症根治手術の問題点

主題I-B-4 乳幼児(2才未満)Fallot四徴症根治手術の問題点

主題I-B-7 ファロー四徴症根治手術-遠隔成績からみた問題点

主題I-B-7 ファロー四徴症根治手術-遠隔成績からみた問題点

Sudden unexpected cardiac arrest in patients after surgical correction for tetralogy of Fallot

Sudden unexpected cardiac arrest in patients after surgical correction for tetralogy of Fallot

Reoperation after total correction of tetralogy of Fallot

Fifteen patients have required repeat heart surgery after total correction of tetralogy of Fallot. Indications for reoperation included recurrent ventricular septal defect (VSD), 9 patients; tricuspid regurgitation, 2 patients; residual right ventricular hypertension, 1 patient; and infection of the right ventriculotomy, 3 patients. From this experience, we have drawn the following conclusions: (1) The need for reoperation after correction of Fallot's tetralogy is unusual; (2) although technically more difficult than the primary operation, the second operation does not cause an excessive mortality rate (13 of 15 survived), and (3) properly selected patients derive substantial benefit from reoperation.

Significance of the pulmonary vascular bed in total correction of tetralogy of fallot

In patients with tetralogy of Fallot, those with intrapulmonary pulmonary arterial stenosis (IPPS) diagnosed by angiocardiographic measurement and pulmonary scintiscanning seem to be poor candidates for one stage total correction. The results obtained in the present study indicate the significance of developmental state of pulmonary vascular bed in establishing indication for total correction of tetralogy of Fallot. In view of the improvement of IPPS following the shunt operation, second-stage total correction after the Blalock shunt is recommended in those with IPPS.

Total correction of tetralogy of Fallot associated with an anomalous left pulmonary artery arising from the aortic arch

A case of tetralogy of Fallot complicated by the anomalous origin of the left pulmonary artery from the aortic arch is reported. Total correction by means of a modified Y-shaped patch with a monocusp porcine valve was performed with success.

Total correction for tetralogy of Fallot with anomalous coronary artery.

From 1955 through 1972, 27 patients with anomalous coronary artery crossing the right ventricular outflow tract in association with tetralogy of Fallot underwent total correction. Eighty percent of these were males, and 17 were less than ten years of age. All anomalies were first discovered at operation, and definitive repair was performed in all but two patients. The most common anomaly was an anterior descending branch arising from the right coronary artery (23 patients). For repair, a single right ventriculotomy was employed in 70 percent. Other procedures used successfully in selected patients were double ventriculotomy, right ventricular outflow conduit, and saphenous vein bypass graft. A palliative pulmonary valvotomy was used in one patient. Eight of the 27 patients died (30 percent); the mortality rate was 100 percent prior to 1961 and 17 percent thereafter. Most deaths resulted from myocardial infarction induced by injury to the anomalous coronary artery. Our experience suggests that in the management of this condition injury to the anomalous artery should be avoided and relief of pulmonary stenosis should be attempted through a ventriculotomy caudal to the anomalous artery or, if necessary, caudal and cephalad to the artery (and closure of the ventricular septal defect). If the stenosis cannot be relieved or if the ratio of right ventricular-to-left ventricular peak pressure is greater than 0.9 after bypass has been discontinued, the operation should be completed by placing a conduit from the caudal ventriculotomy to the main pulmonary artery.

Correction of tetralogy of Fallot in a child with cystic fibrosis

Correction of tetralogy of Fallot in a child with cystic fibrosis

One-Stage Total Correction of Tetralogy of Fallot

One-Stage Total Correction of Tetralogy of Fallot

Total correction of tetralogy of Fallot in infancy

Total correction of tetralogy of Fallot in infancy

Total Correction of Tetralogy of Fallot in Adolescents and Adults

Sixty-four cyanotic patients over 15 years of age with tetralogy of Fallot have undergone total correction. Fifty-one patients had previous shunting procedures. The established intracardiac technique for total repair was used throughout. In 11% (7 of 64) of patients reconstruction of the pulmonary outflow tract was required. Follow-up extends from six months to ten years. Operative mortality was 6.25% (4 of 64). There was one late death. All deaths were technically related and none could be correlated with patient age. Bilaterally functioning Blalock shunts and Potts anastomoses contributed significantly to operative mortality. Abundant collateral circulation exists in older patients with tetralogy of Fallot, and increased bleeding in this series was reflected in a 20.3% (13 of 64) reoperation rate. Survivors represent 92.2% (59 of 64) of the group and all are completely asymptomatic. Approximately one-half of the surviving patients have undergone postoperative catheterization. Of those patients studied, 93.4% (29 of 31) have a good to excellent hemodynamic result following correction. All patients with outflow-tract patches subsequently developed pulmonary insufficiency and right-heart failure. These patients were easily managed on a cardiotonic regimen, however, and digitalis was discontinued in each case by the end of the third postoperative month. These mortality and survivor figures parallel those obtained in our total experience of 250 tetralogy repairs. We believe all patients with tetralogy of Fallot should undergo total correction. Advanced age is no contraindication to surgery. Shunting procedures, when indicated, are to be considered only a preliminary to full correction.

Total Correction of Tetralogy of Fallot After Percutaneous Coiling of MAPCA: A Case Report

DOI: 10.3329/bjch.v32i1.6010 Bangladesh Journal of Child Health 2008; Vol.32(1): 29-32

Correction of tetralogy of Fallot following superior vena cava to pulmonary artery shunt

Correction of tetralogy of Fallot following superior vena cava to pulmonary artery shunt

Results of correction of tetralogy of Fallot in children under four years of age

Results of correction of tetralogy of Fallot in children under four years of age

Total correction of tetralogy of fallot

Total correction of tetralogy of fallot

Correction of tetralogy of Fallot in the young child

Correction of tetralogy of Fallot in the young child

Surgical treatment of cardiac defects associated with corrected transposition of the great vessels.

Corrected transposition of the great vessels is characterized by transposition of the aorta in front and to the left of the pulmonary artery and inversion of the ventricles and atrioventricular valves. Unless it is associated with an intracardiac defect, the circulation of blood inside the heart is normal, and the anomaly may not be recognized clinically. The altered anatomy requires important modifications in the technical features of operative correction of associated cardiac defects. Among 53 patients with corrected transposition of the great vessels, 31 underwent operation for associated intracardiac defects. These were ventricular septal defects (11 patients), tetralogy of Fallot (seven), common ventricle (five), single ventricle (three), tetralogy of Fallot with pulmonary atresia (two), pulmonary stenosis (one), pulmonary atresia (one), and tetralogy of Fallot with common ventricle (one). Postoperative complete heart block, which usually leads to a fatal outcome, may follow closure of ventricular septal defect when conventional techniques are used. Although only one death from heart block occurred in seven patients operated on through a right ventriculotomy, we have employed left ventriculotomy in the last two patients to reduce the risk of heart block and to afford better exposure of the ventricular septal defect. The presence of preoperative complete heart block does not contraindicate correction of associated defects, but consideration should be given to insertion of a pacemaker at the time the lesion is corrected since these patients are likely to have Stokes-Adams attacks later. The anatomical features of associated common ventricle, single ventricle, and tetralogy of Fallot present such severe technical problems that complete correction of these anomalies is accompanied by a high risk. Total correction of tetralogy of Fallot was successfully carried out in only one of seven patients. Others were treated by some form of systemic-pulmonary shunt with good results. Two patients with tetralogy of Fallot and pulmonary atresia and one patient with pulmonary atresia were also treated by systemic-pulmonary shunts and obtained satisfactory palliation. One patient with pulmonary stenosis underwent successful transventricular pulmonary valvulotomy. A ventricular septum was created in five patients with common ventricle. There were only two survivors; the other three died of complete heart block. Recognition of corrected transposition of the great vessels associated with an intracardiac defect that requires operative repair is important because of technical problems that the morphological alterations of ventricular inversion impose.

Surgical correction of tetralogy of Fallot with previous systemic to pulmonary artery shunts.

Fifty-four patients with previous Blalock (32) and Potts (22) systemic artery-pulmonary artery shunts and subsequent total correction for tetralogy of Fallot are reported. A separate posterolateral approach was employed to obliterate the Potts shunt. There were seven operative deaths and two late deaths. Infundibular stenosis with a normal pulmonary valve gave the best results. In comparison with our concomitant series without a shunt, the presence of a Blalock or Potts anastomosis did not affect the over-all result. Postoperative bleeding was a major complication, requiring reoperation in seven. An excellent result with probable cure was obtained in 30, and there was good improvement in ten of the 54 patients.