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European Journal of Cardio-Thoracic Surgery, Vol 9, 453-459, Copyright © 1995 by European Association for Cardio-thoracic Surgery
M Sousa Uva, C Chardigny, L Galetti, F Lacour Gayet, R Roussin, A Serraf, J Bruniaux, A Touchot and C Planche
There is still no consensus regarding the most appropriate protocol for
managing symptomatic patients with tetralogy of Fallot (TOF) presenting
during early infancy. From January 1987 to April 1994, 83 patients with TOF
were operated on at less than 6 months of age. Sixty patients (mean age 109
+/- 5 days) underwent primary repair and 23 (mean age 72 +/- 10 days)
underwent initial palliation with a modified Blalock-Taussig shunt (MBTS)
in 22 cases. No strict protocol was used but patients who received initial
palliation had lower weight, smaller pulmonary annulus or had an anomalous
coronary artery. Nineteen of the patients initially palliated underwent
repair at a median of 13 months after palliation. During this interval, the
pulmonary annulus size increased from a Z- value of -3.0 +/- 0.4 at
palliation to -1.6 +/- 0.7 at repair (P = 0.06) and the summed diameters of
pulmonary artery branches from -2.2 +/- 0.4 to -1.6 +/- 0.7 (P = 0.2).
There were no operative deaths among the repaired patients, but two
patients died early after shunt insertion. Transannular patch was required
in 58% of the patients regardless of the management protocol. Actuarial
survival rate and freedom from reoperation at 48 months were 98.0% and
77.4% (P = 0.003) and 87.6% and 90.0% in primarily repaired and initially
palliated patients, respectively. Primary repair of TOF at the time of
presentation is the preferred approach regardless of age.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Surgery for tetralogy of Fallot at less than six months of age. Is palliation "old-fashioned"?
Hopital Marie Lannelongue, Departement de Chirurgie Cardiaque Pediatrique, Le Plessis Robinson, France.
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 M S. Rao, A. Bhan, S. Talwar, R. Sharma, S. K. Choudhary, B. Airan, A. Saxena, S. S. Kothari, R. Juneja, P. Venugopal, et al. Modified Blalock-Taussig Shunt in Neonates: Determinants of Immediate Outcome Asian Cardiovasc Thorac Ann, December 1, 2000; 8(4): 339 - 343. [Abstract] [Full Text] [PDF]
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C. J. Knott-Craig, R. C. Elkins, M. M. Lane, J. Holz, C. McCue, and K. E. Ward A 26-year experience with surgical management of tetralogy of fallot: risk analysis for mortality or late reintervention Ann. Thorac. Surg., August 1, 1998; 66(2): 506 - 511. [Abstract] [Full Text] [PDF]
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