Surgical treatment of complete atrioventricular septal defect associated with tetralogy of Fallot

The combination of complete atrioventricular septal defect (AVSD) and tetralogy of Fallot (TF) was reported to occur in less than 2% of patients undergoing repair of TF. From September 1981 to November 1989, five consecutive patients with such combination underwent total correction at National Taiwan University Hospital. Their age ranged from 3.8 years to 6.3 years. Two cases were associated with Down's syndrome. All interventricular communications were repaired by combined transatrial and transventricular approach and a separate pericardial patch was used to repair the interatrial communication. The transannular patch (TAP) was not used in one case; of the four cases with TAP, a pericardial monocusp was mounted in one of them. There was one hospital mortality, and one late death. Both were related to intractable right heart failure. We conclude that total repair of this anomaly could be accomplished after 3 years of age provided there is thorough awareness of anatomical features and avoidance of right heart failure.