Postoperative Long-Term Results in Total Correction of Tetralogy of Fallot: Hemodynamics and Cardiac Function

Oku, Hidetaku; Shirotani, Hitoshi; Sunakawa, Akio; Yokoyama, Tatsuo

doi:10.1016/s0003-4975(10)62698-7

Cited by 28 publications

(11 citation statements)

References 19 publications

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“…In another study by the same group using radionuclide ventriculography, depressed left ventricular ejection fraction was found only in postoperative Fallot patients with documented ventricular arrhythmias, not in those without rhythm disturbances 9. In 63 patients after complete repair of tetralogy of Fallot studied using angiocardiography, Oku et al found impaired left ventricular function only in those with a high grade pulmonary regurgitation 10. Marie et al studied 35 postoperative Fallot patients using cardiac catheterisation, echocardiography, and radionuclide angiography and found normal or near normal left ventricular dimensions and ejection fraction in all patients, including those with residual right ventricular pressure overload 12.…”

Section: Discussionmentioning

confidence: 96%

Left ventricular function in adults with mild pulmonary insufficiency late after Fallot repair

Niezen

Helbing

Wall

et al. 1999

Heart

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Objective-To assess left ventricular function in adult Fallot patients with residual pulmonary regurgitation. Setting-The radiology department of a tertiary referral centre. Patients-14 patients with chronic pulmonary regurgitation and right ventricular volume overload after repair of tetralogy of Fallot and 10 healthy subjects were studied using magnetic resonance imaging. (Heart 1999;82:697-703)

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Section: Discussionmentioning

confidence: 96%

Left ventricular function in adults with mild pulmonary insufficiency late after Fallot repair

Niezen

Helbing

Wall

et al. 1999

Heart

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“…The operation was performed under moderate hypothermia (28 °C with the lowest 26 °C), with a membranous oxygenator. The flow was 2.2 to 2.4 L/M 2 . Blood cardioplegia was used in all cases and was given every 25 min.…”

Section: Methodsmentioning

confidence: 99%

Current Strategy of Repair of Tetralogy of Fallot in Children and Adults: Emphasis on a New Technique to Create a Monocusp‐Patch for Reconstruction of the Right Ventricular Outflow Tract

2008

Journal of Cardiac Surgery

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Objectives: In older children (>four years) and adults the strategy of repair of tetralogy of Fallot (TOF) should have a low rate of transannular patch to avoid pulmonary insufficiency (PI), and in addition, we developed a new method of reconstruction of the right ventricular outflow tract (RVOT) to reduce PI. Methods: From 2001 through 2005, 74 patients (50 male, 24 female; mean age of 13.6 ± 0.8 years, ranging from four to 34 years) with TOF (67) or double outlet RV (DORV)‐type‐TOF (seven) underwent complete repair. The resection of RVOT stenosis ± pulmonary valvotomy was principally through RA. A new two‐patch technique to create a folded mono‐cusp valve by using autologous pericardium was applied since August 2004. Results: The repair was through RA in 52 patients and through RA + RVOT/PA in 22 patients (18/4). TAPR was performed in 17 patients (23%, eight non‐valved and nine valved). The aortic cross‐clamp time was 130.1 ± 6.8 min in TAPR group and 85.8 ± 4.6 min in non‐TAPR group (p < 0.0001). The operative mortality was 4.0% (3/74) in all and 2.9% (2/67) in TOF patients (due to low output, uncontrollable bleeding, and repeated bleeding from the pulmonary collateral vessels late) and was similar in TAPR or non‐TAPR. The valved patch‐repaired patients had mild PI and good RV function postoperatively up to eight to 12 months. Conclusions: Repair of TOF in older children/adults should include low rate of TAPR of RVOT. If indicated, the new folded monocusp‐patch technique is recommended. It is an effective and simple way to markedly reduce postoperative PI with no additional cost.

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“…In one study, where pulmonary regurgitation was assessed clinically, there was a significant reduction in right ventricular ejection fraction when it was "moderate or severe".9 In another, where it was assessed subjectively from pulmonary root angiograms, the degree of pulmonary regurgitation was not related to ejection fraction. 7 The methods used in both these studies are subject to criticism. Lange et al used a videodensitometric method to assess the degree of pulmonary regurgitation in their patients after repair.…”

Section: Pressure-volume Relationsmentioning

confidence: 99%

A new technique for the assessment of pulmonary regurgitation and its application to the assessment of right ventricular function before and after repair of tetralogy of Fallot.

Redington

Oldershaw

Shinebourne

et al. 1988

Heart

105

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SUMMARY Biplane right ventriculograms with simultaneous high fidelity pressure recordings were obtained in 24 patients with tetralogy of Fallot. Twelve patients were studied before repair and 12 were studied 67 (42) months after radical surgical repair without the use of a transannular patch. In the patients who had repair right ventricular end diastolic and end systolic volume indices were higher, and the ejection fraction was lower. Time to peak ventricular filling and the peak rate of ventricular filling were also lower in this group and there was a significant relation between peak filling rate and ejection fraction. Postoperative pressure-volume loops from nine patients showed an increase in cavity volume during the decline in right ventricular pressure, which indicated pulmonary regurgitation. The mean regurgitant volume for the group correlated with end diastolic volume index, stroke volume index, and peak filling rate, but not with ejection fraction.These data show that both systolic and diastolic abnormalities of right ventricular function are detected in most patients after radical repair of tetralogy of Fallot. The reduction of ejection fraction previously reported in these patients is unrelated to the degree of pulmonary regurgitation and primarily reflects an impairment of contractile function that presumably is related to intraoperative events. We studied right ventricular function in two discrete groups of patients. Twelve were studied 57

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Postoperative Long-Term Results in Total Correction of Tetralogy of Fallot: Hemodynamics and Cardiac Function

Cited by 28 publications

References 19 publications

Left ventricular function in adults with mild pulmonary insufficiency late after Fallot repair

Left ventricular function in adults with mild pulmonary insufficiency late after Fallot repair

Current Strategy of Repair of Tetralogy of Fallot in Children and Adults: Emphasis on a New Technique to Create a Monocusp‐Patch for Reconstruction of the Right Ventricular Outflow Tract

A new technique for the assessment of pulmonary regurgitation and its application to the assessment of right ventricular function before and after repair of tetralogy of Fallot.

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