Conotruncal repair of tetralogy of Fallot under 2 years old
Nagatsu, M.; Kurosawa, H.; Imai, Y.; Nakata, S.; Kawada, M.; Koh, Y.; Yamagishi, M.; Nakazawa, M.
Nihon Kyobu Geka Gakkai 39(7): 1017-1023
1991
ISSN/ISBN: 0369-4739 PMID: 1894983 Document Number: 375202
From October 1985 to September 1990, a repair within the conotruncal portion of the right ventricle-Conotruncal repair-was used for the primary repair of consecutive 34 patients with tetralogy of Fallot under the age of 2 years. There were three summarized points of this maneuver: the first was non-use of the tricuspid septal leaflet for closure of the ventricular septal defect, the second was short patch infundibuloplasty with a large monocusp, and the last was total resection of the infundibular septum. Length of the patch infundibuloplasty was just 30% of the right ventricle length according to our formula: 30% of RV (cm) = 1.28 X BSA (m2) + 1.10. The VSD patch was placed between the pulmonary annulus and the ventricular septal crest, consisting of the membranous flap and the posterior extension of the trabecula septomarginalis. The right ventricular (RV) to systemic arterial pressure ratio was 0.49 +/- 0.15 (N = 33) and central venous pressure was 10.2 +/- 1.9 cmH2O (N = 33) six hours after ICU admission and 8.4 +/- 1.5 cmH2O (N = 7) 18 days after operation. RV end-diastolic volume showed no increase after operation: 105 +/- 31 before repair to 104 +/- 23% of Normal after repair in the same patients. Post-operative intubation period was 14 +/- 8 hours and hospital admission period was 17 +/- 6 days after operation. All patients were in sinus rhythm. The 28% of patients showed incomplete right bundle branch block (RBBB) and other 28% of patients showed complete RBBB.