Document Detail

Staged repair of tetralogy of Fallot and diminutive pulmonary arteries with a fenestrated ventricular septal defect patch.
MedLine Citation:
PMID:  14666015     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Patients with tetralogy of Fallot and diminutive pulmonary arteries are at risk for suprasystemic right ventricular pressure and right ventricular failure after complete repair. We report the short-term outcome and medium-term follow-up after using a fenestrated ventricular septal defect patch as a component of staged repair in selected patients. METHODS: We reviewed 47 patients with tetralogy of Fallot and diminutive pulmonary arteries whose ventricular septal defect patch was fenestrated, either electively or as a rescue technique, at a single institution between 1984 and 2001. RESULTS: Early mortality was 10.6% and occurred only in patients who underwent rescue fenestration. Review of medium-term follow-up (median, 39 months) revealed 4 late deaths; an additional 4 patients experienced right ventricular failure despite fenestration. Most (7/8) of these late events occurred in patients who underwent planned fenestration. Excessive left-to-right shunt through the fenestration developed in only 2 patients. CONCLUSIONS: Fenestrated patch closure of the ventricular septal defect in patients with tetralogy of Fallot and diminutive pulmonary arteries resulted in 10.6% early mortality. Used preemptively in selected patients, this technique is associated with no surgical mortality and a low incidence of excessive left-to-right shunt (4%). Early survivors remain at risk for late death and right ventricular failure despite fenestration.
Audrey C Marshall; Barry A Love; Peter Lang; Richard A Jonas; Pedro J del Nido; John E Mayer; James E Lock
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  126     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-12-10     Completed Date:  2004-01-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1427-33     Citation Subset:  AIM; IM    
Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
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MeSH Terms
Abnormalities, Multiple / diagnosis,  mortality,  surgery
Cardiac Surgical Procedures / methods*,  mortality*
Child, Preschool
Cohort Studies
Follow-Up Studies
Heart Catheterization
Heart Septal Defects, Atrial / diagnosis,  mortality,  surgery*
Postoperative Complications / diagnosis,  mortality
Pulmonary Atresia
Retrospective Studies
Risk Assessment
Surgical Flaps*
Survival Analysis
Tetralogy of Fallot / diagnosis,  mortality*,  surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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