Complete atrioventricular canal and tetralogy of Fallot: surgical management

Abstract

Between 1982 and 1989, nine patients with complete atrioventricular (AV) canal and tetralogy of Fallot underwent successful repair of both anomalies. Seven patients had Down's syndrome. One or more previous palliative shunts had been used in six patients. Associated cardiovascular lesions included persistent left superior vena cava (two patients), patent ductus arteriosus with marked stenosis of the left pulmonary artery (one patient). The diagnosis was confirmed by cardiac catheterization and cineangiography. Closure of the ventricular septal defect was performed through a combined right atrial and ventricular approach in each patient. The right ventricular outflow obstruction was relieved with the use of a transannular patch (4), right ventricular infundibular patch (4) or a valved external conduit (1). There were no hospital deaths. One patient died as a result of meningitis 2 years after repair. Progressive left AV valve incompetence developed in one patient requiring valve replacement. A single atrial approach may not provide the best exposure of the subaortic end of the defect. In this regard, we recommend an additional right ventriculotomy in order to ensure safe closure of the septal defect. Although an adequately shaped isolated patch could be sufficient to close the anterior VSD, we favour a separate patch to minimize the possibility of producing subaortic obstruction. A further method to avoid this subaortic stenosis consists of dividing the common anterior leaflet to the right towards the lateral extent of the infundibular septum.

Complete Atrioventricular Septal Defect Associated With Tetralogy of Fallot

“…Alonso et al indicated that slight AVVR and pulmonary valve regurgitation are relatively common postoperative findings. 5 We also had various dysfunctions after total correction. In the present series, however, none of the patients had a complication serious enough to require reoperation.…”

“…The latest results have attained an acceptable level, in which the operative mortality ranged from 0 to 11%. [5][6][7][8] However, postoperative problems that need careful management, including reoperation, still exist.…”

“…5,6,8 The optimal criteria, we believe from our experience, are around 8 kg of body weight and 200 or more of PAI. This condition has potentially triple valvular disease whereas AVSD or TOF alone has either double or single valvular deficiency.…”

“…8 Other authors have indicated that the main causes of reoperation are progressive AVVR, 5,6 right ventricular outflow tract obstruction, including pulmonary stenosis, 6,8,17 and residual interventricular shunt. 8,14,18 In addition, there are postoperative complications that do not require reoperation.…”

“…Although the mortality of total correction was high in early reports, 1-4 recent operative outcomes have much improved because of advances in anatomical and clinical recognition of this complex condition. [5][6][7][8][9][10][11] However, postoperative complications such as ventricular septal defect (VSD) recanalization and atrioventricular valvular regurgitation (AVVR) remain high, and some require reoperation. We review our surgical experiences over the past 10 years and the long-term results of this disease, and discuss the relevant surgical management of this lesion.…”