Correction Of Tetralogy Research Articles

Remote magnetic navigation ablation of incisional atrial flutters in adolescent with a giant right atrium after surgical correction of tetralogy of Fallot and Ebstein's anomaly

We describe a clinical case of a 17-years-old adolescent with congenital heart disease after three open-heart surgery procedures for correction of tetralogy of Fallot and Ebstein's anomaly who presented with drug-resistant, persistent atrial flutter and giant right atrium (8.2 cm by transthoracic echocardiography). The successful ablation procedure of the two types of incisional atrial flutter was performed using remote magnetic navigation without any complications with 2.2 minutes of fluoroscopy. The patient remained free of any arrhythmias without antiarrhythmic drugs during 12 months of follow-up with a reduction of right atrium size (5.8 cm by transthoracic echocardiography).

An Intracardiac Foreign Body: A Retained Suture in an Operated Infant with Congenital Heart Disease

Intra-cardiac foreign bodies are a rare occurrence and there is minimal literature on retention of sutures following cardiac surgery. This is an unusual case of a retained intracardiac prolene suture following surgical correction of Tetralogy of Fallot in a 6 month old patient. The patient had an uneventful post-surgical recovery but a foreign body was identified on a routine post-operative transthoracic echocardiogram. Due to the uncertain nature of the structure, the patient underwent fluoroscopy, chest X-ray and a cardiac CT which were unable to identify the nature of the structure. The best modality for identification was echocardiography, which consistently demonstrated the origin, and course of the suture. Due to a high level of suspicion and consistent findings on echocardiograms, the patient underwent surgical exploration 10 days following surgery and a prolene suture was identified originating in the right upper pulmonary vein extending though the mitral and aortic valve to the transverse aortic arch. This was thought to be from the purse string suture used for the left ventricular vent inserted via the right upper pulmonary vein during surgery.

Repair technique for a rare partial anomalous pulmonary venous return associated with retroaortic innominate vein

BackgroundRetroaortic innominate vein (RIV) is a rare vascular abnormality. Although RIV itself is asymptomatic, its presence in patients with partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) is surgically challenging because a simple Warden procedure is impossible.Case presentationA 16-year-old girl was diagnosed with tetralogy of Fallot, secundum, and sinus venosus atrial septal defect (ASD) at birth. She underwent total correction of tetralogy of Fallot and ASD closure at the age of 14-months. However, the diagnosis of PAPVR was missed. At the age of 16, she developed dyspnea on exercise. Echocardiography demonstrated severe pulmonary regurgitation, mild tricuspid regurgitation, and D-shaped left ventricle with paradoxical septal motion along with RIV and sinus venous ASD. Computed tomography confirmed RIV and PAPVR. Systemic and pulmonary venous blood pathways were separated by bovine pericardial patch, and pulmonary valve replacement was performed. Postoperative echocardiography demonstrated improvement of D-shaped left ventricle and laminar flow through the SVC and pulmonary veins. Postoperative computed tomography showed a well-reconstructed SVC and pulmonary venous pathway without stenosis. After an uneventful postoperative course, patient was discharged.ConclusionsPAPVR in patients with RIV may be surgically challenging to repair. We report the first case of successfully repaired PAPVR associated with RIV.

Drop foot Post Mitral Valve Replacement and Total correction of Tetralogy of Fallot: A Two Case Report

Background: Peripheral nerve lesion after heart surgery was reported on brachial plexus, phrenic nerve, laryngeal recurrent nerve facial nerve, lumbosacral root and spinal cord. Incidence of peroneal communis nerve lesion after heart surgery was not much reported (0,19%). Diagnostic procedure of peripheral nerve lesion are including clinical sign and symptom, electrophysiology studies and MRI. Rehabilitation management of peripheral nerve lesion are not only management of pain and nerve stimulation, but also walking aid beside cardiac rehabilitation due to cardiac problem.Methods: Reporting two case of peripheral nerve lesion after heart surgery. First case is a female, 37 years old suffered from drop foot two days after mitral valve replacement with mechanic valve. She got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation program. Second case is a female, 9 years old, after total correction of Tetralogy of Fallot, got drop foot at day two. She also got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation.Results: First case result was the drop foot getting better after she entered phase two of cardiac rehabilitation. In the second case, the drop foot was relieved at phase two cardiac rehabilitation and back to normal condition after one year after surgery.Conclusion: In these two case of drop foot after heart surgery, the drop foot was relieved after pain and rehabilitation management beside cardiac rehabilitation.

Intraoperative video demonstration of a MiECC type III circuit for the correction for Tetralogy of Fallot

Intraoperative video demonstration of a MiECC type III circuit for the correction for Tetralogy of Fallot

P446Role of native T1 mapping in assessment of patients post correction of tetralogy of Fallot

P446Role of native T1 mapping in assessment of patients post correction of tetralogy of Fallot

Right ventricular remodeling after conduit replacement in patients with corrected tetralogy of Fallot - evaluation by cardiac magnetic resonance

PurposeTo evaluate the potential for right ventricular reverse remodelling after pulmonary valve replacement using cardiac magnetic resonance imaging, in adults with corrected tetralogy of Fallot and severe pulmonary insufficiency.Material and methodsTen patients with previous correction of tetralogy of Fallot with severe pulmonary insufficiency accepted for pulmonary valve replacement were evaluated prospectively with cardiac magnetic resonance imaging preoperatively and re-evaluated 10 ± 5 months postoperatively. Follow up for survival was 100% complete with mean of 37 ± 12 months.ResultsThe preoperative mean indexed right ventricular end-diastolic volume was reduced from 161 ± 33 ml/m2 to 120 ± 23 ml/m2 postoperatively, p < 0.001. The preoperative mean indexed right ventricular stroke volume was reduced from 72 ± 20 ml/m2 to 50 ± 6 ml/m2 postoperatively, p = 0.002. After pulmonary valve replacement, the right ventricular ejection fraction did not change significantly (46% versus 42%, p = 0.337). Pulmonary insufficiency fraction decreased from 49% ± 11 to 1% ± 1 postoperatively, p < 0.001.ConclusionsPulmonary valve replacement leads to a favourable early reverse remodelling with a reduction in RV volumes and improved function in all patients regardless of their preoperative indexed right ventricular volume.

The effects of pulmonary valve replacement on QRS duration in repaired tetralogy of Fallot patients with pulmonary regurgitation

IntroductionChronic pulmonary regurgitation (PR) following surgical correction in Tetralogy of Fallot (TOF) leads to right ventricular (RV) dysfunction, arrhythmias and sudden cardiac death (SCD). Pulmonary valve replacement (PVR) decreases PR and improves RV function, but data regarding QRS duration reduction remain scarce. MethodsAll adult TOF patients undergoing transcatheter PVR or surgical PVR from 2010 to 2016 were included. Clinical characteristics and QRS duration were measured and compared to post-intervention QRS duration using an institutional software and manually verified. Significantly wide QRS was defined as QRS >140 ms. ResultsOf 133 PVR patients, 85 had TOF and 27 (21.1%) had QRS > 140 ms (14 transcatheter, 13 surgical) and were included in this analysis. A 6 ms decrease in QRS duration was seen at 3-year follow-up (168.0 ± 3.5 ms vs. 161.8 ± 3.5 ms, p = .04). There was a significant decrease in the median RV size (defined as RV/LV diameter ratio) pre-intervention to 3-year post-intervention: (0.96 vs 0.89, p = .03).The median PR decreased significantly from moderate-severe to mild post-intervention (p < .0001). ConclusionsReplacement of the pulmonary valve in high risk TOF patients reduces QRS duration at 3 years. Further study is needed to assess whether this QRS duration reduction may identify patients at lower risk of ventricular arrhythmias.

Early Outcomes after Total Correction for Tetralogy of Fallot Patients at Department of Cardiothoracic and Vascular Surgery Amiri Medical Complex Kabul-Afghanistan (A Single Center Study)

Early Outcomes after Total Correction for Tetralogy of Fallot Patients at Department of Cardiothoracic and Vascular Surgery Amiri Medical Complex Kabul-Afghanistan (A Single Center Study)

Радикальная коррекция тетрады Фалло с отсутствием левой легочной артерии с помощью Т-образной моностворчатой заплаты

Радикальная коррекция тетрады Фалло с отсутствием левой легочной артерии с помощью Т-образной моностворчатой заплаты

Effects of acute normovolemic hemodilution on hemodynamics and oxygen supply in adult patients undergoing correction of tetralogy of Fallot

Objective To evaluate the effects of acute normovolemic hemodilution (ANH) on hemodynamics and oxygen supply in adult patients undergoing correction of tetralogy of Fallot. Methods Ten consecutive patients, aged 20-59 yr, weighing 41-61 kg, of American Society of Anesthesiologists physical status Ⅲ-Ⅳ, scheduled for elective correction of tetralogy of Fallot, were enrolled in the study.After induction of anesthesia, ANH was performed when hemodynamics was stable and stroke volume variation (SVV) ≤10%.Blood was withdrawn from the femoral artery, the blood collected was expected to be 15% of blood volume, and the shed blood was reinfused after the end of cardiopulmonary bypass.The blood loss was simultaneously replaced with the equal volume of 6% hydroxyethyl starch.Heart rate, mean arterial pressure, central venous pressure, cardiac output, SVV and peripheral vascular resistance were recorded before ANH and at 5 min after the end of ANH.Blood samples were collected for determination of hemoglobin and blood gas analysis, arterial oxygen saturation, arterial oxygen partial pressure and lactate concentrations were recorded, and oxygen supply was calculated. Results Compared with the baseline before ANH, cardiac output was significantly increased, and peripheral vascular resistance and hemoglobin were decreased after ANH (P 0.05). Conclusion ANH can increase cardiac output and maintain oxygen supply and hemodynamics stable when used for adult patients undergoing correction of tetralogy of Fallot. Key words: Hemodilution; Tetralogy of Fallot; Hemodynamics; Oxygen

Value of transesophageal echocardiography in estimating pulmonary arterial index and pulmonary vein index for guiding total correction of tetralogy of Fallot

Objective To investigate the value of transesophageal echocardiography (TEE) in estimating pulmonary arterial index (PAI) and pulmonary vein index (PVI) for guiding total correction of tetralogy of Fallot (TOF). Methods 80 patients with TOF were studied. TEE was used to measure the diameters of left and right pulmonary arteries and four pulmonary veins at pre-operation, PAI and PVI were calculated and analyzed statistically. Results There was significant correlation between PAI and PVI (r=0.853, P=0.000). Receiver operator characteristic curve (ROC curve) analysis showed that the area under the ROC curve of PAI and PVI in detecting prolonged stay in intensive care unit (ICU) after operation were 0.704, 0.781, the border value were 147.25, 286.42 mm2/m2, the sensitivity were 90%, 100%, and the specificity were 74%, 74%, respectively. The area under the ROC curve of PAI and PVI in detecting prolonged mechanical ventilation after operation were 0.817, 0.789, the border value were 152.48, 302.12 mm2/m2, the sensitivity were 90%, 90%, and the specificity were 75%, 77%, respectively. The area under the ROC curve of PAI and PVI in detecting low cardiac output syndrome after operation were 0.955, 0.926, the border value were 130.55, 209.09 mm2/m2, the sensitivity were 100%, 83%, and the specificity were 90%, 89%, respectively. Conclusion TEE can be used as a quantitative method to evaluate PAI and PVI in patients with TOF, there is significant correlation between the two indices, PAI and PVI carry higher sensitivity and specificity in detecting prolonged stay in ICU, prolonged mechanical ventilation and low cardiac output syndrome after operation. Key words: Transesophageal echocardiography; Tetralogy of Fallot; Pulmonary arterial index; Pulmonary vein index

Радикальная коррекция тетрады Фалло с одновременным устранением ложной аневризмы выводного отдела правого желудочка после ранее выполненной реконструкции его путей оттока

Образование ложной аневризмы выводного отдела правого желудочка сердца – крайне редкое осложнение, встречающееся в детской кардиохирургии. Данное сообщение демонстрирует случай успешной радикальной коррекции тетрады Фалло и устранения ложной аневризмы правого желудочка, развившейся через 9 месяцев после выполненной реконструкции путей оттока правого желудочка с помощью ксеноперикардиальной заплаты.

Aortopathy following the correction of tetralogy of Fallot

Aortopathy following the correction of tetralogy of Fallot

Rapid Fire Abstract session: assessing the single ventricule and new techniques for assessing tetralogy477Echocardiographic assessment of ventricular function and predictors of mortality in adults with a Fontan circulation478The left pulmonary artery doppler in the assessment of atrial restriction after the hybrid procedure for hypoplastic left heart syndrome479Magnetic resonance imaging in patients with Fontan physiology detects a high prevalence of liver

Rapid Fire Abstract session: assessing the single ventricule and new techniques for assessing tetralogy477Echocardiographic assessment of ventricular function and predictors of mortality in adults with a Fontan circulation478The left pulmonary artery doppler in the assessment of atrial restriction after the hybrid procedure for hypoplastic left heart syndrome479Magnetic resonance imaging in patients with Fontan physiology detects a high prevalence of liver

Abstract 15592: Role of Electroanatomic Voltage Mapping for Risk Stratification in Patients With Repaired Congenital Heart Disease Involving the Right Ventricle

Introduction: Among adult patients with previous surgical correction for Tetralogy of Fallot or other repaired Congenital Heart Disease (rCHD) involving the RV, ventricular arrhythmias (VA) and sudden cardiac death (SCD) represent a late complication. The imparied haemodynamics that lead to RV dilatation and overload could also alterate its electroanatomic structure. Hypothesis: 3D electroanatomic mapping (EAM) of the RV could confirm the presence of myocardial electrical abnormalities, allowing to better identify patients at risk for life-threatening arrhythmias. Methods: 146 patients (age 19.2 ±7.0) with rCHD involving the RV were selected from a population undergoing routine post-surgical follow-up, according to the presence of VA or severe RV dilatation. These patients underwent 3D EAM of the RV. We tested the correlation between size of scar tissue (areas with voltage &lt; 0.5 mV) and several parameters universally accepted by the literature as risk factors for VA in this particular patient population. Results: In 125 (85.6%) patients, EAM demonstrated areas of low voltage in the antero-lateral RVOT. In 20 of these (16%, 13.7% of the total) the scar extended to the septum. 72 (49.3%) had a peritricuspid scar, and in 20 (13.7%) other areas of the RV were interested. Total low-voltage area, expressed as % of total endocardial area, was significantly higher in patients with history of PVCs [3.2% (±2.6) vs 2.2% (±1.8), p&lt;0.05], complex PVCs at 24h-Holter ECG (Lown class ≥2) [3.4 (±2.5) vs 2.6 (±2.3), p&lt;0.05], exercise-inducible PVCs [3.8 (±2.4) vs 2.6 (±2.2), p=0.01] and history of previous shunt [4.0 (±2.7) vs 2.6 (±2.2), p=0.01]. Scar size was also positively correlated with age (p=0.01), age at correction (p=0.01) and QRS duration on surface ECG (p&lt;0.05). Conclusions: In patients with rCHD involving the RV it is common to observe endocardial low-voltage areas with variable distribution, not always corresponding to the sites of surgical lesion. Morover, the size of the scar tissue area correlates with some of the parameters which have been already identified as risk factors for life-threatening arrhythmias and SCD in adult patients with CHD. We suggest that EAM should become part of the routine tests for the stratification of arrhythmic risk in this population.

Cerebral protective effect of dexmedetomidine in pediatric patients undergoing correction of tetralogy of Fallot with cardiopulmonary bypass

Objective To evaluate the cerebral protective effect of dexmedetomidine in the pediatric patients undergoing correction of tetralogy of Fallot with cardiopulmonary bypass (CPB) . Methods Sixty pediatric patients of both sexes, aged 11 months-14 yr, with body mass index of 9.8-21.4 kg/m2, of ASA physical status Ⅱ or Ⅲ, scheduled for elective correction of tetralogy of Fallot with CPB, were randomly divided into 2 groups (n=30 each) using a random number table: normal saline group (group NS) and dexmedetomidine group (group Dex) . Dexmedetomidine was infused intravenously at a dose of 0.5 μg/kg over 10 min before induction of anesthesia, followed by 0.5 μg·kg-1·h-1 infusion until the end of surgery.The equal volume of normal saline was given instead in group NS.Before induction of anesthesia (baseline, T0) , and at 10 min after induction (T1) , after re-warming to 36 ℃ (T2) , and at 1, 6, 24, 48 and 72 h after termination of CPB (T3-7) , blood samples were obtained from the radial artery and jugular venous bulb for blood gas analysis, jugular venous oxygen saturation (SjvO2) and jugular venous oxygen partial pressure (PjvO2) were recorded, and cerebral O2 extraction rate (CERO2) and arteriovenous blood O2 content difference (Da-jvO2) were calculated.The concentrations of S-100β protein and neuron-specific enzyme (NSE) in serum were determined by enzyme-linked immunosorbent assay at T0 and T3-7.The time for mechanical ventilation, duration of intensive care unit stay, and development of postoperative complications were recorded. Results Compared with the baseline value at T0, the serum concentrations of S-100β and NSE were significantly increased at T3-7, and SjvO2 and PjvO2 were increased, and CERO2 and Da-jvO2 were decreased at T2 in both groups.Compared with group NS, the serum concentrations of S-100β and NSE were significantly decreased at T3-7, and no significant changes were found in the time for mechanical ventilation, duration of intensive care unit stay, and incidence of sinus bradycardia, hypotension, and re-intubation in group Dex.The parameters of cerebral oxygen metabolism were all within the normal range in both groups, and there was no significant difference between the two groups. Conclusion Dexmedetomidine infused intravenously at a dose of 0.5 μg/kg before induction of anesthesia, followed by 0.5 μg·kg-1·h-1 infusion until the end of surgery, provides cerebral protection in the pediatric patients undergoing correction of tetralogy of Fallot with CPB. Key words: Dexmedetomidine; Tetralogy of Fallot; Cardiopulmonary bypass; Brain; Child

Cardiac magnetic resonance image of late pulmonary artery aneurysm after total correction of tetralogy of Fallot

Cardiac magnetic resonance image of late pulmonary artery aneurysm after total correction of tetralogy of Fallot

NT-proBNP as a biomarker of right ventricular dilatation and pulmonary regurgitation in Tetralogy of Fallot

Background After surgical correction of Tetralogy of Fallot (TOF), residual pulmonary regurgitation (PR), right ventricular (RV) dilatation and RV failure have been associated with adverse clinical events and are considered criteria for pulmonary valve replacement. Cardiovascular magnetic resonance imaging (CMR) is the gold-standard for evaluation of these parameters. However it is an expensive technique which is not readily available in all hospitals and outpatient clinics. NT-proBNP is a biomarker which may overcome these CMR limitations and might be used as a cost-effective biomarker for monitoring patients with TF. The aim of this study is to evaluate whether NTproBNP plasma levels may help as a biomarker for monitoring ventricular dilatation, pulmonary valve regurgitation and heart failure in patients with repaired TF

ASSA14-06-02 Correction of Tetralogy of Fallot in 252 Adult Patients

Objective To evaluate the early results of correction of tetralogy of Fallot in adult patients. Methods From January 2007 to May 2014, 252 patients with tetralogy of Fallot, who were older than 14 years of age, underwent complete surgical repair at our institution. There were 143 male and 109 female patients in the study. Results The mean operating time, cardiopulmonary bypass time and aortic cross clamp time were 215.2 ± 38.3, 99.4 ± 35.6 and 50.5 ± 18.2 min respectively. The ratio of the right ventricular pressure to the aorta pressure measured just after repair was 0.43 ± 0.18. All the gradients across the right ventricular outflow tract were less than 30 mmHg. The mean postoperative mechanic ventilation time was 18.6 ± 2.92 h. The mean hospital stay after repair was 13.42 ± 2.39 days. There were 2 operating deaths with the operative mortality being 0.79%. Both of the causes of deaths were low output syndrome resulting in multiple organ failure. Conclusions Complete repair of tetralogy of Fallot in adults is feasible with acceptable early mortality and morbidity.