Surgical Management of Tetralogy of Fallot at NICVD

Abstract

MATERIAL AND METHODS:

One Hundred and fifty patient’s age 0.1 to 26 years were included in the study. Ninety Two patients had primary correction which was performed using cardiopulmonary bypass, moderate hypothermia and cardioplegia. The repair involved closure of ventricular septal defect with a Dacron patch and resection of infundibular stenosis through a vertical ventriculotomy. The mortality data was available in all 150 patients but complete analysis of data was available in 121 patient; 74/92 patients underwent primary correction and in 47/58 patients had shunting operations.

RESULTS:

ANGIGRAPHIC QUANTITYATIVE ANALYSIS

In 56/150 patients with Tetra logy of Fallot quantititative analysis of the angiograms showed that right pulmonary artery (RPA) was approximately one half the diameter of the ascending Aorta (AA); (RPA/AA ratio = 0.49 + 0.19) and mean RPA diameter was slightly smaller than the mean descending aorta diameter, (Mean RPA/descending Aorta (DA) ratio = 0.9 + 0.28 respectively.

DISCUSSION:

Pediatric cardiac surgery was started on regular basis at NICVD in 1980. In the earlier period of our management of patients with Tetra logy of Fallot we deliberately selected older children for shunt surgery, who were severely symptomatic and severely cyanosed. However in the later period criteria for shunt operation and primary correction were developed. The use of Hypothermia and cardioplegia now allows for a great relaxation of the heart and thus this approach of respecting the right ventricular outflow tract without ventriculotomy need to be retried since the integrity of conduit over succeeding years cannot be assured. It is concluded that over the 2.5 years of our surgical experience greater and younger patients are undergoing palliative and corrective operations with improved survival.