Transventricular repair of tetralogy of Fallot

Abstract

When the preoperative assessment suggests that the pulmonary valve annulus is of adequate size, repair through the right atrium seems the best option. However, when the annulus is obviously small and a transannular patch will be needed, a ventriculotomy will be needed, and a small extension allows an adequate view of the VSD. This is a very satisfactory approach, and particularly when the repair is performed in infancy (which seems to be the current trend), late arrhythmias are very infrequent. When the annulus size is equivocal, either approach can be used and even a combination of ventricular and transatrial methods used to close the VSD. The results with both approaches are now very good, but an increased recurrence of RVOTO has been reported with the transatrial approach, presumably because of inadequate resection of obstructing muscle in the RVOT. Because transannular patches cause pulmonary regurgitation, many patients will come to late pulmonary valve replacement. However, even when the pulmonary valve is preserved, late regurgitation may occur and all these patients need careful follow-up. © 2005 Elsevier Inc. All rights reserved.