Total Correction of Tetralogy of Fallot

Wolf, Muriel D.; Landtman, B; Neill, Catherine A.; Taussig, Helen B.

doi:10.1161/01.cir.31.3.385

Cited by 34 publications

(11 citation statements)

References 10 publications

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“…This approach resulted in relatively good long-term survival 7 . However, residual lesions after repair were common and follow-up studies of these first operations showed that these residual lesions resulted in late morbidity and mortality 8– 11 . Pulmonary regurgitation (PR) was reported in the majority of patients, more commonly in those with TAPs 12 .…”

Section: Surgical Approaches To Repairmentioning

confidence: 99%

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Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.

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Section: Surgical Approaches To Repairmentioning

confidence: 99%

“…RV dilation, in turn, was associated with ventricular arrhythmia and biventricular dysfunction 13– 15 . Furthermore, patients were noted to be at higher risk of sudden cardiac death 8, 9, 11, 16, 17 .…”

Section: Surgical Approaches To Repairmentioning

confidence: 99%

Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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“…In addition to Kirklin, surgeons from other centers were reporting on their experiences with complete repair of TOF [36–40]. Mortality in the early years of repair was as high as 60%, but by the early 1960s perioperative mortality decreased significantly to 7%–14%.…”

Section: Surgical Treatment—early Yearsmentioning

confidence: 99%

Tetralogy of Fallot: Yesterday and Today

Starr

2009

World j. surg.

128

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Tetralogy of Fallot (TOF) is a cyanotic congenital cardiac defect that was first described by Stenson in 1672 and later named for Fallot, who in 1888 described it as a single pathological process responsible for (1) pulmonary outflow tract obstruction, (2) ventricular septal defect (VSD), (3) overriding aortic root, and (4) right ventricular hypertrophy. The surgical history of TOF began with the development of the systemic to pulmonary artery shunt (BT shunt) by Blalock, Taussig, and Thomas in 1944. Ten years later complete repair of TOF was performed by Lillehei using cross-circulation and by Kirklin with a primitive cardiopulmonary bypass circuit. Notable contributions by several other surgeons including Bahnson, Ebert, Malm, Trusler, Barratt-Boyes, and Castaneda would lead us into the modern era of surgery. Today, complete repair of TOF is performed before six months of age with low mortality (<2%). In select cases a modified version of the BT shunt is still performed as the initial procedure. Long-term survival rates are excellent (85%-90%). Adult survivors with TOF are an ever-increasing population and may require reintervention, surgically or catheter based. Promising future innovations include percutaneous pulmonary valve replacement, tissue-engineered autologous valves and conduits, and genetic manipulation. This article presents a review of TOF, including the history of surgical treatment, present-day approaches, and long-term outcomes.

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“…Overall mortality was 31% with 42 deaths during the hospital stay, but 3 deaths occurred suddenly several months after surgery. 2 The arrhythmic outcomes in TOF were assessed in 1977 by Gillette et al 3 -a true pioneer in electrophysiology. His group assessed data on 51 children with TOF who underwent postoperative intracardiac electrophysiology studies (EPS).…”

Section: See Article By Waldmann and Bessière Et Almentioning

confidence: 99%