Surgical correction of tetralogy of Fallot: general dominant world practice and current trends

  • O. Borodinova Ukrainian Children’s Cardiac Center
Keywords: tetralogy of Fallot, surgical correction, the current trend

Abstract

The first successful correction of Tetralogy of Fallot was done in August 31, 1954 by surgeons C. W. Lillehei and R. L. Varco. Since that time the problem of its correction is under constant development and improvement due to the ab-sence of an ideal solution.

The purpose of the paper – to review different methods of Tetralogy of Fallot surgical correction from literature, their advantages, disadvantages and to determine the optimal technique of Tetralogy of Fallot correction.

Results and discussions. Correction of the tetralogy of Fallot with transventricular closure of the ventricular septum de-fect, ventriculotomy and transannular plasty still remains the method of choice in most centers. This is due to several factors. For the first, methods with transatrial/transpulmonary closure of the ventricular septum defect and minimal transanular plasty or with preservation of the pulmonary artery valve are characterized by an increased complexity of intraoperative technique and a dificulty in the training of specialists. Secondly, these patients are expected to have a more severe periopera-tive period and a potentially high risk of reoperations due to residual obstruction of the right ventricular outflow tract. Thus, method of ToF repair is mostly a personal surgeon’s choice guided by his own experiences, feelings and measurements of cardiac structures on a cardioplegic heart.

Conclusion. Different methods of surgical correction of Tetralogy of Fallot, their advantages, disadvantages, immediate and long-term results have been presented on the literature basis. According to this information, the traditional method of surgical correction of Tetralogy of Fallot is transventricular closure of ventricular septal defect with expanded ventriculotomy and transannular plasty, despite the high risk of sudden death and the need of pulmonary artery valve implantation in a re-mote period. Correction of Tetralogy of Fallot with transatrial/transpulmonary ventricular septal defect closure and minimal transannular plasty or preservation of the pulmonary artery valve have performed better survival and less risk of reinterven-tions on the outflow tract of the right ventricle. However, the question of feasibility, efficacy and safety of this technique re-mains controversial due to the lack of echocardiographic and intraoperative quality and safety control criteria for performed correction and long-term follow-up data.

References

1. Long-term results after early primary repair of tetralogy of Fallot / Bacha E., Scheule A., Zurakowski D. et al. // J Thorac Cardiovasc Surg. – 2001. – Vol. 12. – P. 154–61.

2. Results of reparative surgery for tetralogy of Fallot: data from the European Association for Cardio-Thoracic Surgery Congenital Database / Sarris G., Comas J., Tobota Z. et al. // European Journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. – 2012 Nov. – Vol. 42 (5). – P. 766–74.

3. Valve-Sparing Tetralogy of Fallot Repair With Intraoperative Dilation of the Pulmonary Valve / Victor Bautista-Hernandez, Ivonne Cardenas, Isaac Martinez-Bendayan et al. // Pediatr Cardiol. – 2013. – Vol. 34. – P. 918–923.

4. Effect of Right Ventricular Outflow Tract Obstruction on Right Ventricular Volumes and Exercise Capacity in Patients With Repaired Tetralogy of Fallot / Hendrik G. Freling, Tineke P. Willems, Joost P. Van Melle et al // Am J Cardiol. – 2014. – Vol. 113. – P. 719–23.

5. Starr J. P. Tetralogy of fallot: yesterday and today / Starr J. P. // World journal of surgery. – 2010 Apr. – Vol. 4. – P. 658–68.

6. Akram Allam. Fate of Right Ventricle Outflow Gradient After Fallot Repair / Akram Allam, Amre Hashem // Journal of The Egyptian Society of Cardio-Thoracic Surgery. – 2012. – Vol. 22, № 2. – P. 53–8.

7. Right ventricular function In adults with repaired tetralogy of Fallot assessed with cardiovascular Magnetic resonance imaging: detrimental role of right ventricular Outflow aneurysms or akinesia and adverse right-to-left ventricular Interaction / Davlouros P., Kilner P., Hornung T. et al. // J Am Coll Cardiol. – 2002. – Vol. 40. – P. 2044–2052.

8. Stark J. Surgery for congenital heart defects / J. Stark, M. de Leval, V. Tsang / Third edition, 2012. – P. 668–702.

9. Tal Geva. Tetralogy of Fallot repair: Ready for a new paradigm / Tal Geva // J ThoracCardiovascSurg. – 2012. – Vol. 143. – P. 1305–6.

10. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair / Nollert G., Fischlein T., Bouterwe S. et al. // J Am Coll Cardiol. – 1997. – Vol. 30. – P. 1374–83.

11. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot / Murphy J., Gersh B., Mair D. et al. // N Engl J Med. – 1993. – Vol. 329. – P. 593–9.

12. Late right heart reconstruction following repair of tetralogy of Fallot / Miller D., Rossiter S., Stinson E. et al. // Ann ThoracSurg. – 1979. – Vol. 28. –P. 239–51.

13. Yves d’Udekem. Low Risk of Pulmonary Valve Implantation After a Policy of Transatrial Repair of Tetralogy Of Fallot Delayed Beyond the Neonatal Period: The Melbourne Experience Over 25 Years / Yves d’Udekem // J Am Coll Cardiol. – 2014. – Vol. 63. – P. 563–8.

14. Vladimiro L. Vida. Preservation of the pulmonary valve during early repair of tetralogy of fallot: surgical techniques / Vladimiro L. Vida // Pediatric Cardiac Surgery Annul. – 2016. – Vol. 19. – P. 75–81.
Published
2017-09-11
How to Cite
1.
Borodinova O. Surgical correction of tetralogy of Fallot: general dominant world practice and current trends. ujcvs [Internet]. 2017Sep.11 [cited 2024Dec.22];(2 (28):47-2. Available from: https://cvs.org.ua/index.php/ujcvs/article/view/165
Section
CONGENITAL HEART DEFECTS