Transatrial-transpulmonary correction of tetralogy of Fallot: experience of a developing country

Abstract

Introduction: Right ventricular dysfunction is a cause of morbidity and mortality after surgical correction of tetralogy of Fallot. The transatrial-transpulmonary approach allows preservation of right ventricular function. Aim: To report the immediate and long-term results of surgical treatment of tetralogy of Fallot using the transatrial-transpulmonary approach. Material and methods: This is a retrospective study including cases of tetralogy of Fallot operated on by the transatrial-transpulmonary approach between April 2009 and October 2010 in our institution. Results: There were 19 patients including 10 girls and 9 boys with a mean age of 7.4 years (extremes: 3 and 19 years). All our patients benefited from closure of the ventricular septal defect by a right atrial approach and enlargement of the pulmonary pathway. In the immediate postoperative period, the pressure gradient between the pulmonary artery and the right ventricle was 18.77 mm Hg. We had 2 deaths (10.5%). Complications were dominated by conduction disorders (100%) such as right bundle branch block and pleuropulmonary complications (41.20%). After a mean follow-up of 11.43 ±0.81 years, no patient died and all were asymptomatic, without significant residual lesion. Conclusions: Complete cure of tetralogy of Fallot by the transatrial-transpulmonary route is associated with low morbidity and mortality in our experience. The long-term results are satisfactory.

Tetralogy of Fallot in Low- and Middle-Income Countries

“…Indeed, more than half of the patients experienced dyspnea, syncope, chest pain, and seizures. 12 , 13 , 17 , 21 , 22 , 23 In HICs, patients are typically operated pre-emptively between 3 and 11 months or as an emergency after the appearance of ToF spells. In contrast, the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC), a study regrouping >2000 patients from 32 centres in 20 LMICs, found that 54% of patients operated on for ToF were over 1 year old.…”

“… 22 45 patients Median age at the time of surgery: 21 years (range: 15-44 years) India 42% of patients with long-standing hypoxia have significant MAPCAs All these patients should have preoperative catheterization Souaga et al. 23 19 patients Mean age at the time of surgery: 7.4 ± 4.52 years Ivory Coast Perioperative mortality = 10.5% mortality Perioperative morbidity = 17.6% of right heart failure, low cardiac output = 11.8%, and transient complete AV block = 5.9% AV, atrioventricular; CHD, congenital heart disease; CHU, Centre Hospitalier Universitaire; LMIC, low- and middle-income country; MAPCA, major aortopulmonary collateral artery; NYHA, New York Heart Association; PRV/LV, right ventricular-left ventricular systolic pressure ratio; RVOT, right ventricular outflow tract; ToF, tetralogy of Fallot. …”