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Tetralogy of Fallot with type C complete atrioventricular canal: surgical repair in three cases
Insights
This study reports successful surgical repair of tetralogy of Fallot with complete atrioventricular canal type C in three infants. The innovative technique achieved satisfactory outcomes, highlighting a viable surgical approach for this complex congenital heart defect.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Tetralogy of Fallot (TOF) is a complex cyanotic congenital heart disease.
- Complete atrioventricular canal (CAVC) type C presents significant surgical challenges, especially when associated with TOF.
- Successful surgical management of combined TOF and CAVC type C requires precise anatomical understanding and tailored surgical techniques.
Purpose of the Study:
- To report the successful surgical repair of three consecutive cases of tetralogy of Fallot associated with complete atrioventricular canal type C.
- To describe the surgical techniques employed for anatomical correction.
- To evaluate the early postoperative outcomes of this complex congenital heart repair.
Main Methods:
- Preoperative diagnosis confirmed by right and left ventriculography.
- Surgical repair involved closure of ventricular septal defects with Dacron patches.
- Reconstruction of atrioventricular valves using native tissue and precise suture placement.
- Relief of right ventricular outflow tract obstruction via infundibulectomy, pulmonary valvulotomy, and patch augmentation or valved conduit placement.
Main Results:
- Successful biventricular repair was achieved in all three patients.
- Postoperative conditions were satisfactory at six months.
- Patients' medical management varied, with one on digitalis, another on digitalis and diuretics, and the third requiring no medication.
Conclusions:
- The study demonstrates the feasibility and success of surgical repair for the rare combination of tetralogy of Fallot and complete atrioventricular canal type C.
- The described surgical modifications for atrioventricular valve reconstruction and septal defect closure are effective.
- Satisfactory early outcomes suggest this approach offers a viable treatment option for this complex pediatric cardiac condition.
Abstract:
The successful repair of three consecutive cases of tetralogy of Fallot associated with complete atrioventricular canal type C is reported. The correct preoperative diagnosis was established by right and left ventriculography. Operative repair in the first two patients involved division of both hemivalves above the crest of the ventricular septal defect and closure of the septal defects with a single large Dacron patch. In the third patient, the septal defects were closed with two separate patches. The undivided hemivalves were attached to the patches by interrupted sutures placed more to the right side of the midline, so that tricuspid tissue was used to reconstitute the mitral valve. Right ventricular outflow tract obstruction was relieved by infundibulectomy, pulmonary valvulotomy, and placement of a Darcon patch on the infundibulum in Cases 1 and 3. A valved tube was used in Case 2. Six months postoperatively, the condition of the patient is satisfactory. The first patient is receiving digitalis; the second, digitalis and diuretics; and the third patient is well without treatment.
