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Long-term results after palliative intra-cardiac repair for tetralogy of Fallot and diminutive pulmonary arteries

Published online by Cambridge University Press:  20 June 2019

Yoichi Kawahira Open the ORCID record for Yoichi Kawahira [Opens in a new window] ,
Kyoichi Nishigaki ,
Koji Kagisaki ,
Takuji Watanabe  and
Kazuki Tanimoto
Yoichi Kawahira*
Affiliation:
Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
Kyoichi Nishigaki
Affiliation:
Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
Koji Kagisaki
Affiliation:
Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
Takuji Watanabe
Affiliation:
Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
Kazuki Tanimoto
Affiliation:
Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
*
Author for correspondence: Yoichi Kawahira, MD, Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka 534-0021, Japan. Tel: +81-6-6929-1221; Fax: +81-6-6929-1091; E-mail: [email protected]
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Abstract

Background:

In patients with tetralogy of Fallot with the diminutive pulmonary arteries, we sometimes have to give up the complete intra-cardiac repair due to insufficient growth of the pulmonary arteries. We have carried out palliative intra-cardiac repair using a fenestrated patch.

Methods:

Of all 202 patients with tetralogy of Fallot in our centre since 1996, five patients (2.5%) with the diminutive pulmonary arteries underwent palliative intra-cardiac repair using a fenestrated patch. Mean operative age was 1.8 years. Previous operation was Blalock–Taussig shunt in 4. At operation, the ventricular septal defect was closed using a fenestrated patch and the right ventricular outflow tract was enlarged. Follow-up period was 9.8 ± 2.6 years.

Results:

There were no operative and late deaths. Fenestration closed spontaneously on its own in four patients 2.7 ± 2.1 years after the intra-cardiac repair with a stable haemodynamics; however, the last patient with the smallest pulmonary artery index had supra-systemic pressure of the right ventricle post-operatively. The fenestration was emergently enlarged. Systemic arterial oxygen saturation was significantly and dramatically increased from 83.5 to 94% after the palliative intra-cardiac repair, and to 98% at the long term. A ratio of systolic pressure of the right ventricle to the left was significantly decreased to 0.76 ± 0.12 at the long term. Now all five patients were Ross classification class I.

Conclusion:

Although frequent catheter and surgical interventions were needed after the palliative intra-cardiac repair, this repair might be a choice improving quality of life with good results in patients with tetralogy of Fallot associated with the diminutive pulmonary arteries.

Keywords

Palliative intra-cardiac repairlong-term resultfenestrated patchtetralogy of Fallotdiminutive pulmonary artery
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 8 , August 2019 , pp. 1036 - 1039
Copyright
© Cambridge University Press 2019 

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