Long-term results after palliative intra-cardiac repair for tetralogy of Fallot and diminutive pulmonary arteries.

Abstract

BACKGROUND:

In patients with tetralogy of Fallot with the diminutive pulmonary arteries, we sometimes have to give up the complete intra-cardiac repair due to insufficient growth of the pulmonary arteries. We have carried out palliative intra-cardiac repair using a fenestrated patch.

METHODS:

Of all 202 patients with tetralogy of Fallot in our centre since 1996, five patients (2.5%) with the diminutive pulmonary arteries underwent palliative intra-cardiac repair using a fenestrated patch. Mean operative age was 1.8 years. Previous operation was Blalock-Taussig shunt in 4. At operation, the ventricular septal defect was closed using a fenestrated patch and the right ventricular outflow tract was enlarged. Follow-up period was 9.8 ± 2.6 years.

RESULTS:

There were no operative and late deaths. Fenestration closed spontaneously on its own in four patients 2.7 ± 2.1 years after the intra-cardiac repair with a stable haemodynamics; however, the last patient with the smallest pulmonary artery index had supra-systemic pressure of the right ventricle post-operatively. The fenestration was emergently enlarged. Systemic arterial oxygen saturation was significantly and dramatically increased from 83.5 to 94% after the palliative intra-cardiac repair, and to 98% at the long term. A ratio of systolic pressure of the right ventricle to the left was significantly decreased to 0.76 ± 0.12 at the long term. Now all five patients were Ross classification class I.

CONCLUSION:

Although frequent catheter and surgical interventions were needed after the palliative intra-cardiac repair, this repair might be a choice improving quality of life with good results in patients with tetralogy of Fallot associated with the diminutive pulmonary arteries.

• Authors: Yoichi Kawahira, Kyoichi Nishigaki, Koji Kagisaki, Takuji Watanabe, Kazuki Tanimoto
• Journal: Cardiology in the young (Cardiol Young) Vol. 29 Issue 8 Pg. 1036-1039 (Aug 2019) ISSN: 1467-1107 [Electronic] England
• PMID: 31218971 (Publication Type: Journal Article)

Topics

• Cardiac Surgical Procedures (methods)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Heart Septal Defects, Ventricular (surgery)
• Hemodynamics
• Humans
• Infant
• Japan
• Male
• Postoperative Complications
• Postoperative Period
• Pulmonary Artery (surgery)
• Quality of Life
• Tetralogy of Fallot (mortality, surgery)
• Treatment Outcome