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Surgical management of complete atrioventricular canal associated with tetralogy of Fallot
A Bertolini1, P Dalmonte, G L Bava
1Department of Cardiovascular Surgery, Giannina Gaslini Institute, Children's Hospital, Genoa, Italy.
Insights
Surgical repair of atrioventricular canal and tetralogy of Fallot in children had a high mortality rate (33%) due to low cardiac output and infection, particularly with transannular patch use.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Surgical Outcomes
Background:
- Atrioventricular canal and tetralogy of Fallot are complex congenital heart defects requiring surgical intervention.
- Early surgical repair is crucial for improving outcomes in affected children.
- Combined defects present unique surgical challenges.
Purpose of the Study:
- To evaluate the outcomes of surgical repair for children with atrioventricular canal and tetralogy of Fallot.
- To analyze mortality and morbidity associated with different surgical techniques.
- To assess long-term functional status after repair.
Main Methods:
- Retrospective review of 12 children undergoing surgical repair between 1984 and 1993.
- Detailed analysis of surgical techniques including ventricular septal defect closure and right ventricular outflow tract reconstruction.
- Assessment of hospital mortality, follow-up mortality, and echocardiographic findings.
Main Results:
- High hospital mortality rate of 33% (4 deaths), primarily from low cardiac output and infection.
- Higher mortality observed in patients receiving a transannular patch.
- Significant rates of moderate-to-severe mitral and tricuspid regurgitation noted on follow-up.
Conclusions:
- Surgical repair of atrioventricular canal and tetralogy of Fallot in this cohort was associated with substantial early mortality.
- The choice of surgical technique, particularly the use of a transannular patch, may influence outcomes.
- Long-term complications include significant valvular regurgitation and the need for reoperation.
Abstract:
Between 1984 and 1993, 12 children with an atrioventricular canal and tetralogy of Fallot underwent surgical repair. The mean(s.d.) age at operation was 58(18) months, and the mean(s.d.) body weight 15(4) kg. Nine patients underwent 11 palliative procedures. The ventricular septal defect was closed through a combined (right atrial and right ventricular) approach in nine cases, and through a right atrial approach in three, using a prosthetic patch with a wide anterior extension, secured with a running suture. The 'ostium primum' defect was closed with a separate prosthetic patch in 11 cases (double-patch technique). Right ventricular outflow obstruction was relieved by a composite infundibular patch (seven cases) or a transanular patch (five). There were four hospital deaths (33%). These were caused by low cardiac output in three cases and infection in one (three deaths occurred in patients with a transanular patch). One patient has so far died during follow-up. Assessment at 50(36) months by echo-Doppler showed moderate-to-severe 'mitral' regurgitation in three cases, and moderate 'tricuspid' regurgitation with right ventricular dysfunction in one case. Two patients have required further surgery.