The Surgical Treatment of the Tetralogy of Fallot

Barnard, C. N.; Schrire, V.

doi:10.1136/thx.16.4.346

Cited by 17 publications

(10 citation statements)

References 26 publications

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Haemodynamic and cine-angiocardiographic findings after one-stage repair of Fallot's tetralogy.

Gotsman¹

1966

Heart

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One-stage repair of Fallot's tetralogy is a satisfactory operative procedure with an acceptable mortality, provided the operation is undertaken by a team who are skilled in managing this heart lesion (Kirklin et al., 1959;Barnard and Schrire, 1961;Malm et al., 1963). The clinical results in the survivors are rewarding because the change in status is remarkable. Several recent reports on the haemodynamics have emphasized the clinical well-being of the patients. The present study set out to confirm this clinical impression, to assess the long-term improvement in the anatomy of the outflow tract, and to study the response of the heart and pulmonary circulation to exercise. PATIENTS AND METHODSEleven patients with the most severe pre-operative disability who had undergone a one-stage repair operation of Fallot's tetralogy were selected from a group of 34 long-term survivors. They were cyanosed before operation with clubbing of the fingers. Three were having recurrent episodes of extreme cyanosis. They were small (below the 25th percentile of height and weight for age). The right ventricle was dominant with a short systolic ejection murmur in the pulmonary area and a loud, apparently single second sound in the aortic area. Electrocardiography, chest radiograph, cardiac catheterization, and selective angiocardiography confirmed the presence of severe cyanotic Fallot's tetralogy, with marked obstruction to the outflow tract of the right ventricle and a large right-to-left shunt through the ventricular septal defect.Pulmonary valvotomy and infundibular resection was performed in all the patients: in 10 an outflow tract prosthesis was inserted, and in 7 it was carried across the pulmonary valve ring into the pulmonary artery. Two patients had such severe outflow tract obstruction that there was only a probe patent communication between the body of the right ventricle and the pulmonary artery. The ventricular septal defect was closed by Received April 26, 1965. * Present address: The Cardiac Clinic, Groote Schuur Hospital Observatory, Cape, South Africa. 448 direct suture in 6 and with a teflon patch in 5. Six patients in whom the prosthesis was extended into the pulmonary artery had severe residual pulmonary incompetence.The patients were all well, living a normal life, and with a near normal exercise tolerance. They were able to run up four flights of stairs, a vertical height of 60 ft. (18-3 m.), without becoming short of breath. The finger clubbing disappeared.In the presence of pulmonary incompetence, the right ventricle was hyperdynamic with a long systolic ejection murmur heard best in the pulmonary area, a single second sound of aortic valve closure, and a diamondshaped early diastolic murmur which was delayed 0 04 sec. after aortic valve closure. Complete right bundle-branch block was present in all the patients (Fig. 1). The pulmonary vascularity had become normal but the heart size had increased since operation. A convex left middle segment was present in patients with an outflow tract prosthesis (Fig. 2). Pul...

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Haemodynamic and cine-angiocardiographic findings after one-stage repair of Fallot's tetralogy.

Gotsman¹

1966

Heart

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“…The incidence of residual ventricular septal defect varied from 15 to 22% in previous published reports ( Barnard and Schrire, 1966;Lillehei, Levy, Adams, and Anderson, 1964). In cases of doubt on oxygen analysis, we used an ascorbate dilution technique to rule out a shunt.…”

Section: Results Of Surgerymentioning

confidence: 99%

Total surgical correction of tetralogy of Fallot: Results in 45 consecutive cases

John

Bhati

Shatapathy

et al. 1972

Thorax

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Total surgical correction of the tetralogy of Fallot remains a most challenging and difficult problem in cardiac surgery. The present study, like others, indicates that this lesion can be corrected, and excellent anatomical and haemodynamic results can be obtained with an acceptable mortality.Results following total surgical correction in 45 consecutive patients are presented. The operative mortality was 13 %. The causes of death are analysed. Certain uncommon severe associated defects adversely influenced the outcome of the operation. The great majority of surviving patients are improved. Postoperative haemodynamic studies in eight patients revealed gratifying results.In 1955, after 10 years of palliative surgery using various shunt operations, Lillehei accomplished the first successful total surgical correction of the tetralogy of Fallot (Lillehei et al., 1955). The early mortality after the corrective operation was high, often in the range of 40% ; but today in most centres the operative mortality has been reduced to about 10°, (Kirklin, Wallace, McGoon, and DuShane, 1965;Malm et al., 1966;Zerbini, 1969 The symptomatology before operation is illustrated in Table II. Of the 45 patients, 39 had central cyanosis of varying degree and six were acyanotic.Most of these cases were moderately symptomatic and belonged to functional class ii to iii, while six had severe cyanosis with anoxic spells (class iv, NYHA classification). Three of the 45 patients had episodes of congestive failure, in two of whom aortic incompetence complicated the lesion. Two

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“…The infundibular stenosis usually present is resected as widely as possible. In the majority of patients the outflow tract is increased in size with a rectangular gusset of woven, crimped Teflon fashioned from an aortic graft (Barnard and Schrire, 1961). This is extended across the pulmonary valve as far as the left pulmonary artery whenever necessary to construct an adequate outflow tract.…”

Section: Disturbances Of the Acid-base Balance-mentioning

confidence: 99%