Transatrial resection of the obstructed right ventricular infundibulum.

Abstract

Obstructions of the right ventricular infundibulum were resected through the orifice of the tricuspid valve in 21 patients, 15 of whom had tetralogy of Fallot. At operation the systolic pressure difference between the right ventricle and pulmonary artery after repair averaged 18 mm Hg (range 0-40 mm Hg). In patients with tetralogy, cardiac index four hours after operation averaged 2.8 L/M2/min. One patient with tetralogy and severe pulmonary hypertension died. Twelve patients with tetralogy were recatheterized 10 to 186 days after operation. The mean systolic pressure difference between right ventricle and pulmonary artery was 23 mm Hg. Residual obstructions were in the pulmonary valvular annulus. Cineangiograms did not show paradoxical motion of the right ventricular wall. Transatrial resection of right ventricular infundibular obstructions carries with it none of the consequences that often follow right ventriculotomy and this surgical approach satisfactorily relieves infundibular obstructions.

Right Ventricular Dysfunction Due to Right Ventricular Outflow Tract Patch

“…However, in transatrial repair, the incision starts from the pulmonary artery rather than the mid ventricle, such as in the transventricular approach. 17,18 Although the transatrial approach necessitates wide resection of the inner muscular features of the pulmonary infundibulum, one can hope that this approach may better preserve the contractile function of the subpulmonary area. We would submit that preservation of pulmonary valve function and avoiding or limiting RVOT and transannular patching, and perhaps avoidance of extensive RVOT myectomy, are likely to preserve long-term RV systolic function.…”

The Role of Tricuspid Valve Surgery in the Late Management of Tetralogy of Fallot

“…4,5,7 –9 Resection of hypertrophied muscle bundles provides an alternative means of relieving RVOT without causing significant PR when the pulmonary annulus is of adequate size. 48 In 1976, Edmunds et al 49 described RV infundibulum resection as a safe approach to treating outflow tract obstruction that does not injure chordae or papillary muscles. This procedure nevertheless carries the potential to disrupt the tricuspid tensor apparatus.…”

Quality of life after repair of tetralogy of Fallot

“…We considered three aspects of surgical procedure; previous palliative surgery, transjunctional patching, and ventriculotomy, because of their previously reported affect on outcome. [14][15][16][17] As expected for patients having surgery on average 20 years ago, there were very few patients with transatrial repair, or without a transjunctional patch, and this precluded meaningful comparisons. Age at operation is reported to be related to long term survival.…”