Ninety-one patients with tetralogy of Fallot underwent intracardiac repair between 1978 and 1981. One patient died from left-sided heart failure. Retrospective analyses of this death revealed a significant decrease of the left ventricular (LV) end-diastolic volume index (EDVI) of 21 ml/m2 (36% of normal). Results of early postoperative hemodynamic studies after total correction of this anomaly suggested that an EDVI of 30 ml/m2 is the minimal requirement for adequate cardiac output postoperatively. Based on these data, 3 patients with decreased LV volume with EDVI of around 30 ml/m2 were challenged with the primary repair with success, although they required atrial pacing and catecholamine support postoperatively to maintain adequate left atrial pressure and cardiac output. From these results, it is recommended that patients with tetralogy of Fallot and an EDVI of 30 ml/m2 or more can be considered as candidates for the primary repair, but that patients with an EDVI of less than 30 ml/m2 should be palliated once by systemic-to-pulmonary arterial shunt procedures. Subsequent total correction should be performed after sufficient LV growth for those patients.

Adolescent↗

PubMed1985

Right ventricular function after extracardiac conduit repair for tetralogy of Fallot. A comparison among surgical approaches.

Right ventricular volume measurements and hemodynamic studies were performed in 20 patients after total correction of tetralogy of Fallot. There were 6 patients with an extracardiac conduit and Hancock xenograft (G-1), 8 with an outflow tract patch (G-2) and 6 without or with a minimal right ventriculotomy and repair of pulmonary valve (G-3). The age at the time of operation was over 3 years in each patient and averaged 5 +/- 2 (mean +/- SD) years. Right ventricular systolic pressure averaged 81 +/- 22, 55 +/- 22 and 58 +/- 30 mmHg in G-1, G-2 and G-3, respectively. Right ventriculography showed no contraction of the right ventricular free wall at the anastomosis to the conduit and poor contraction around the anastomosis in G-1. The right ventricular enddiastolic volume index (RVEDVI) was 114 +/- 31, 155 +/- 57 and 115 +/- 28 ml/m2 in G-1, G-2 and G-3, respectively. The right ventricular ejection fraction (RVEF) was 0.42 +/- 0.11 in G-1, 0.53 +/- 0.04 in G-2 (p less than 0.05, vs G-1) and 0.57 +/- 0.04 in G-3 (p less than 0.02, vs G-1). Pulmonary regurgitation was evident in 17 patients, and RVEDVI correlated well with degrees of pulmonary incompetence. Fourteen patients in G-2 and G-3 were divided into G-A and G-B to evaluate right ventricular function with or without pressure overloading of the right ventricle. G-A consisted of 7 patients with a right ventricular systolic pressure of more than 50 mmHg (74 +/- 26) and G-B of 7 patients with a value less than 50 mmHg (39 +/- 4). There was no difference in RVEDVI and RVEF between G-A and G-B. RVEF was significantly lower in G-1 than G-A (p less than 0.02) and G-B (p less than 0.05). These results suggested that an extracardiac conduit with Hancock xenograft reduced the contraction of the right ventricular free wall and induced a depressed right ventricular pump function in patients with a high right ventricular pressure.

Bioprosthesis↗

PubMed1985