• Journal of Chest Surgery
• /
• v.19 no.4
• /
• pp.578-583
• /
• 1986

Tetralogy of Fallot is the most common cyanotic congenital anomaly, which needs some operation for the survival. Perioperative mortality of the Tetralogy of Fallot was lowered remarkably in recent years, but some discussions were presented for the criteria of the corrective surgery and the corrective method of the pulmonary stenosis. In the Department of Thoracic and Cardiovascular Surgery of the Chunbug National University Hospital, 17 cases of tetralogy of Fallot were corrected totally from July in 1983 to August in 1984. In correction of the pulmonary stenosis, transannular patch was applied in B patients, infundibulectomy in 5, RVOT patch without transannular patch in 3, and isolated patches on RVOT and pulmonary trunk. Preoperative and early postoperative hemodynamic study revealed increased RA pressure in transannular patch group, which was significant statistically. [p<0.01]. Clinically, perioperative death occurred only in transannular patch group, and right heart failure signs including hepatomegaly, ascites, pleural effusion and peripheral edema were high in frequency in transannular patch group.

• Journal of Chest Surgery
• /
• v.24 no.6
• /
• pp.560-569
• /
• 1991

The surgical management of symptomatic tetralogy of Fallot in infants is debatable. From November 1986 to August 1990, 21 infants under 10 kg of the body weight with tetralogy of Fallot underwent primary repair. Mean body weight was 8.6$\pm$1.40kg. All the patient were clubbing and there were cyanotic except for 1 patient. Transannular patch was laid down in 8 patients. Right ventricular outflow patch was used with Goretex but pericardial patch was utilized in 3 patients at the initial period of operation. Incidence of the complications following total correction of tetralogy of Fallot was more frequent in the patients placed with transannular patch compared to the patients with right ventricular outflow tract patch. Two deaths occurred in the 21 patients, Hospital mortality was 9.4%, but there were no operative deaths in the patients who transannular patch was laid down. Causes of deaths were low cardiac output.

• Journal of Chest Surgery
• /
• v.22 no.1
• /
• pp.74-82
• /
• 1989

Ninety-six patients with tetralogy of Fallot have undergone either primary total correction [71], staged total correction [9], or an initial shunt [16], between January, 1984, and December, 1987 Their mean age was 9.5 years, mean body weight 24kg, and mean body surface area 0.86m2. Initial palliative shunt group had smaller size, smaller pulmonary artery, and higher hemoglobin [P value < 0.05 >. Modified Blalock-Taussig shunt was performed most commonly. Patch enlargement of right ventricle in 31 cases [38%], right ventricle and pulmonary artery in 7 cases [9%], transannular patch enlargement in 28 cases [35%], and valved conduit in 2 cases [2.5%] was performed for reconstruction of right ventricular outflow tract stenosis. Longer aorta cross clamp time was noted in case of separate patch enlargement of right ventricle and pulmonary artery, and dead patient with transannular patch enlargement [P value < 0.05]. There was no operative death in shunt group, but 7 deaths in total correction group [mortality rate 8.8%].

• Journal of Chest Surgery
• /
• v.25 no.8
• /
• pp.832-836
• /
• 1992

A 25-month-old patient with complete atrioventricular septal defect and Tetralogy of Fallot underwent repair of both anomalies. The diagnosis was established preoperatively by 2D-echocardiography, cardiac catheterization and cardioangiogram, Repair was accomplished using cardiopulmonary bypass and profound hypothermia to 18C, Closing of the atrioventricular septal defect was achieved with the use of two Dacron patchs by an atrial approach alone. Infundibulectomy and outflow tract reconstruction with the transannular pericadial patch containing a monocusp were performed. Upon the postoperative evaluation by 2D-echocardiography, mitral regurgitation was absent, but a tiny dehiscence of ventricular patch and minimal tricuspid regurgitation were noticed.

• Journal of Chest Surgery
• /
• v.49 no.5
• /
• pp.344-349
• /
• 2016

Background: Monocusp reconstruction with a transannular patch (TAP) results in early improvement because it relieves residual volume hypertension during the immediate postoperative period. However, few reports have assessed the long-term surgical outcomes of this procedure. The purpose of the present study was to evaluate the mid-term surgical outcomes of tetralogy of Fallot (TOF) repair using monocusp reconstruction with a TAP. Methods: Between March 2000 and March 2009, 36 patients with a TOF received a TAP. A TAP with monocusp reconstruction (group I) was used in 25 patients and a TAP without monocusp reconstruction (group II) was used in 11 patients. We evaluated hemodynamic parameters using echocardiography during the follow-up period in both groups. Results: At the most recent follow-up echocardiography (mean follow-up, 8.2 years), the mean pulmonary valve velocities of the patients in group I and group II were $2.1{\pm}1.0m/sec$ and $0.9{\pm}0.9m/sec$, respectively (p=0.001). Although the incidence of grade 3-4 pulmonary regurgitation (PR) was not significantly different between the two groups (group I: 16 patients, 64.0%; group II: 7 patients, 70.0%; p=0.735) during the follow-up period, the interval between the treatment and the incidence of PR aggravation was longer in group I than in group II (group I: $6.5{\pm}3.4years$; group II: $3.8{\pm}2.2years$; p=0.037). Conclusion: Monocusp reconstruction with a TAP prolonged the interval between the initial treatment and grade 3-4 PR aggravation. Patients who received a TAP with monocusp reconstruction to repair TOF were not to progress to pulmonary stenosis during the follow-up period as those who received a TAP without monocusp reconstruction.

• Journal of Chest Surgery
• /
• v.17 no.4
• /
• pp.636-643
• /
• 1984

For the purpose of avoiding postoperative massive pulmonary insufficiency after transannular outflow tract reconstruction in patients with tetralogy of Fallot, we have used monocusp bearing outflow patch since June 1983. Right heart catheterization and pulmonary arteriography were performed in 7 patients among the total 11 patients corrected with monocusp bearing outflow patch during postoperative 14th day to 22nd day. Particular attention was paid to the evaluation of the pulmonary valve competence, and the results were; 1.One patient died of acute renal failure secondary to low cardiac output and the operative mortality was 9.1%. 2.The average PRV/FA ratio was 0.491 and the average systolic pressure gradient between right ventricle and pulmonary artery was 17.7mmHg. The average Qp/Qs was 1.13. 3.Inspite of using monocusp bearing outflow patch, the hemodynamic and pulmonary arteriographic results were unsatisfactory in respect to pulmonary valve competence.

• Journal of Chest Surgery
• /
• v.24 no.2
• /
• pp.115-122
• /
• 1991

From April 1986 to December 1989, 25 infants under the age of 12 months with tetralogy of Fallot were operated on. Age ranged from 3 to 12 months[mean 8.9$\pm$4.9 months] and mean body weight was 7.8$\pm$ 2.6kg. All the patients were deeply cyanotic, 12 of them experienced anoxic spell. Transannular patch was laid down in 19 patients, in 7 of them monocuspid patch was utilized. Postrepair P RV/LV was measured at operation room in 17 patients[mean 0.48$\pm$0. 14]. Hospital mortality was 20Yo. Causes of deaths include right ventricular failure and low cardiac output. The mortality was closely related with patient`s age and body surface area at operation. Also higher mortality was noticed in patients having major associated anomaly or previous palliative operation, preoperative management with propranolol and transannular repair. 18 patients were followed up for 12 to 50 months with a mean follow-up time of 24 months after operation. There were no late deaths and late ventricular arrhythmia or congestive heart failure was not detected as yet. Redo operation was performed in one case because of residual pulmonic stenosis. Considering several advantages of early primary repair, primary repair of symptomatic infants with tetralogy of Fallot should be encouraged despite somewhat high mortality rate as yet and better results could be anticipated along with improvement of myocardial protection method and postoperative care.

• Journal of Chest Surgery
• /
• v.35 no.6
• /
• pp.460-462
• /
• 2002

We experienced primary repair of complete atrioventricular septal defect with Teralogy of Fallot. The diagnosis was established preoperatively by echocardiography, cardiac catheterization and cardioangiography. Repair was accomplished using cardiopulmonary bypass. Two patch techinque were performed using Dacron patch for ventricular septal defect and pericardial patch for atrial septal defect. Infundibullectomy and right ventricular outflow tract reconstruction with the transannular pericardial patch were performed. The postoperative echocardiography showed mild mitral and tricuspid regurgitation, but there were no hemodynamic abnormalities.

• Journal of Chest Surgery
• /
• v.33 no.5
• /
• pp.419-421
• /
• 2000

Noonan syndrome is characterized by typical facies, congenital heart defect, and some clinical features similar to Turner syndrome, but with normal chromosomes. The most commonly associated cardiac defects are pulmonary valvular stenosis and strial septal defect. We experienced a case of Nonan syndrome associated with pulmonay valve stenosis with double-chambered right ventricle and atrial septal defect and cryptorchidism. Pulmonary valvotomy was done through transannular incision. Hypertrophied muscle bundles were excised. Atrial septal defect was closed directly. RVOT was reconstructed with pericardial transannular patch. Orchiopexy was performed simultaneously without any problem.

• Journal of Chest Surgery
• /
• v.21 no.3
• /
• pp.574-582
• /
• 1988

Endocardial cushion defects is a rare congenital heart disease. We experienced two complete endocardial cushion defects[ECD] and three partial ones, which were successfully repaired between 1986 and 1987. In a patient of complete ECD, associated with secundum ASD, Pulmonary stenosis and Down`s syndrome, the atrial and ventricular septal defects were closed separately with bovine pericardium and Dacron patches respectively, and then pulmonary stenosis was relieved by transannular patch widening in addition to valvotomy and infundibulectomy. In another patient with complete ECD, small interventricular communication was closed with simple suture with pledget and primum ASD was closed with pericardial patch. In first patient of partial ECD, primum atrial septal defect was closed with pericardial patch. In second patient of partial ECD, associated with secundum ASD, direct closure of secundum ASD and patch closure of primum ASD were performed. In third patient of partial ECD, associated with patent foramen ovale[PFO], primum ASD was closed with bovine pericardial patch and PFO was closed directly. In all patient except third patient of partial ECD, mitral clefts were closed with three or four 5-0 prolene interrupted sutures. Transient A-V dissociation developed postoperatively in two patients and transient nodal rhythm developed postoperatively in other two patients. Heart failure in complete ECD with Down`s syndrome was overcome with medical treatment.