REPAIR OF TETRALOGY OF FALLOT

IN THE FIRST THREE MONTHS OF

LIFE
TRANSATRIALTRANSPULMONARY APPROACH
Vladimiro Vida, M.D.

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

Period: January 1991 December

2001
20 males

35 pts (<

3 months of age)

15 females

Excluded:

TOF + AVSD
TOF + PA

Department of Cardiovascular Surgery

TOF + APVS
TOF + DORV
University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

SURGICAL TECHNIQUES (1)

TRANSATRIAL- TRANSPULMONARY
APPROACH
TRANSATRIAL-TRANSPULMONARY
MYOTOMY/

MYECTOMY

(RESECTION

OF

PARIETAL EXTENSION OF INFUNDIBULAR

SEPTUM)
NO VENTRICULOTOMY (OR MINIMAL=5-6
mm)
of Cardiovascular Surgery
Department
TRANSATRIAL
VSD CLOSURE University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

SURGICAL TECHNIQUES (2)

TYPE OF RVOT RECONSTRUCTION

Pts

MONOCUSP TAP

20 (57.2%)

(HOMOGRAFT)

AUTOLOGOUS PERIC. TAP

NO PATCH
Department of Cardiovascular Surgery

11 (31.4%)
4 (11.4%)
University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

SURGICAL TECHNIQUES (3)

ASSOCIATED SURGICAL PROCEDURES

n

LPA PLASTY
LPA from descending aorta
reimplantation

Department of Cardiovascular Surgery

3
1

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

INTRAOPERATIVE ECHOCARDIOGRAPHY

EPICARDIAL IN ALL
POST OPERATIVE EVALUATION FOR
VSD, OBSTRUCTION, VENTRICULAR
FUNCTION

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

INTRAOPERATIVE RV/LV
GRADIENT (mmHg)

RV/LV < 0.4 IN

ALL

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

SURGICAL RESULTS
1 HOSPITAL DEATH (2.8%)
CAUSE: LAD FROM RCA DISTORTION

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

MAJOR POSTOPERATIVE SEQUELAE

Pts
- LOS
Inotropes infusion for > 48 hrs
ECMO support for 41 days

3
2

- Prolonged intubation > 7 days

1
Department of Cardiovascular Surgery
University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

FOLLOW UP (1)

2 months 10.2 years (mean 3.6

years)

NO LATE DEATHS
34 Pts are asymptomatic in NYHA class I
Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

FOLLOW UP (2)

LATE REOPERATIONS (3 pts - 8.5%)

Pts Interval
(months)

Residual RVOTO

Residual RVOTO + LPA sten.1

Residual LPA stenosis

74
5
49

No reoperations for residual VSD

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

FOLLOW UP (3)

LATE REINTERVENTIONS (4 pts 11.7%)

Pts
LPA balloon dilatation

4*

* 1 pt LPA from desc. aorta

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

FOLLOW UP (4)

% survival
97.1%

97.1%

100
80
% 60
40
20
0
0

10

years

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

FOLLOW UP (5)

Freedom from reintervention

97.1%

92%

100
80
% 60
40
20
0
0

82.2%

82.2%

10

years

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

ECHOCARDIOGRAPHIC FOLLOW UP
Pts

ph
Peripheral
PA branch stenosis
moderate

RV pressure > 40 mmHg

PVR absent/mild

32

PVR moderate

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

COMMENT (1)

Transatrial Transpulmonary
approach can be applied in
early
infancy
with
low
operative risk, good early
hemodynamic results and low
incidence of residual lesions
Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

COMMENT (2)

The use of monocusp pulmonary

Homograft patch in patients
requiring transannular patch
seems to minimize pulmonary
regurgitation,
RV
failure,
improving
the
early
postoperative course
Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

COMMENT (3)

Echocardiographic data at the

follow-up
suggest
that
RV
geometry and function is better
preserved when a transatrial transpulmonary
approach
is
employed as compared to a
classic transventricular approach
G. Stellin, O. Milanesi et al.
Ann thorac Surg, 60:588-91, 1995

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

COMMENT (4)

The
higher
incidence
of
transanular patch in this age
group is justified by the
severity of this malformation,
in most of our cases

Department of Cardiovascular Surgery

University of Padua - Italy

REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF

LIFE

COMMENT (5)

We believe that early repair of

congenital
heart
anomalies
neutralizes secondary damage
to vital organs improving the
quality of life, in the long term

Department of Cardiovascular Surgery

University of Padua - Italy

University of Padua

Universa Universis Patavina Libertas