Total Correction of Tetralogy of Fallot: Do We Still Need Trans annular Patch

Iqbal Hussain Pathan, Aftab Ahmed Khatri, Saad Bader Zaki

Abstract

Objective

To evaluate early results after surgical repair for tetralogy of Fallot; to find out the trends of repair technique and outcomes at NICVD.

Study design

Descriptive case series.

Place & Duration of study

Department of Paediatric Cardiac Surgery, National Institute of Cardiovascular Diseases Karachi, from January 2016 to December 2016.

Methodology

All patients operated for total correction of tetralogy of Fallot were included in the study. Each patient was followed for three months  post repair and echocardiography was used for final assessment of gradient across right ventricular outflow tract.

Results

A total of 74 patients who underwent surgical repair of tetralogy of Fallot were included in the study. There were 45 (61%) males and 29 (39%) females with an  age range from  2 year to 13 year. Mean age was 6.3 year. Repair was done through ventriculotomy with trans  annular patch (TAP) in seven patients. Sixty-seven patients were operated without ventriculotomy. Patients in whom TAP was used had more severe pulmonary regurgitation, delayed extubation and long ICU stay than patients where repair was performed without ventriculotomy. Follow up echocardiography showed residual right ventricular outflow obstruction in patients operated without ventriculotomy and trans annular patch placement with mild obstruction in 29 (43%) patients while  moderate and  severe  right ventricular outflow tract obstruction found in 36 (56%) and  2 (3%) patients  respectively. All patients who underwent trans annular patch placement had  moderate right ventricular outflow tract obstruction.

Conclusion

Despite  concern about residual right ventricular outflow tract obstruction after correction of  tetralogy of Fallot,  our data showed moderate obstruction is well tolerated postoperatively.

Key words

Tetralogy of Fallot, Trans annular patch, Echocardiography.