• Journal of Chest Surgery
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• v.24 no.6
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• pp.560-569
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• 1991

The surgical management of symptomatic tetralogy of Fallot in infants is debatable. From November 1986 to August 1990, 21 infants under 10 kg of the body weight with tetralogy of Fallot underwent primary repair. Mean body weight was 8.6$\pm$1.40kg. All the patient were clubbing and there were cyanotic except for 1 patient. Transannular patch was laid down in 8 patients. Right ventricular outflow patch was used with Goretex but pericardial patch was utilized in 3 patients at the initial period of operation. Incidence of the complications following total correction of tetralogy of Fallot was more frequent in the patients placed with transannular patch compared to the patients with right ventricular outflow tract patch. Two deaths occurred in the 21 patients, Hospital mortality was 9.4%, but there were no operative deaths in the patients who transannular patch was laid down. Causes of deaths were low cardiac output.

• Journal of Chest Surgery
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• v.25 no.8
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• pp.832-836
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• 1992

A 25-month-old patient with complete atrioventricular septal defect and Tetralogy of Fallot underwent repair of both anomalies. The diagnosis was established preoperatively by 2D-echocardiography, cardiac catheterization and cardioangiogram, Repair was accomplished using cardiopulmonary bypass and profound hypothermia to 18C, Closing of the atrioventricular septal defect was achieved with the use of two Dacron patchs by an atrial approach alone. Infundibulectomy and outflow tract reconstruction with the transannular pericadial patch containing a monocusp were performed. Upon the postoperative evaluation by 2D-echocardiography, mitral regurgitation was absent, but a tiny dehiscence of ventricular patch and minimal tricuspid regurgitation were noticed.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.460-462
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• 2002

We experienced primary repair of complete atrioventricular septal defect with Teralogy of Fallot. The diagnosis was established preoperatively by echocardiography, cardiac catheterization and cardioangiography. Repair was accomplished using cardiopulmonary bypass. Two patch techinque were performed using Dacron patch for ventricular septal defect and pericardial patch for atrial septal defect. Infundibullectomy and right ventricular outflow tract reconstruction with the transannular pericardial patch were performed. The postoperative echocardiography showed mild mitral and tricuspid regurgitation, but there were no hemodynamic abnormalities.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.574-582
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• 1988

Endocardial cushion defects is a rare congenital heart disease. We experienced two complete endocardial cushion defects[ECD] and three partial ones, which were successfully repaired between 1986 and 1987. In a patient of complete ECD, associated with secundum ASD, Pulmonary stenosis and Down`s syndrome, the atrial and ventricular septal defects were closed separately with bovine pericardium and Dacron patches respectively, and then pulmonary stenosis was relieved by transannular patch widening in addition to valvotomy and infundibulectomy. In another patient with complete ECD, small interventricular communication was closed with simple suture with pledget and primum ASD was closed with pericardial patch. In first patient of partial ECD, primum atrial septal defect was closed with pericardial patch. In second patient of partial ECD, associated with secundum ASD, direct closure of secundum ASD and patch closure of primum ASD were performed. In third patient of partial ECD, associated with patent foramen ovale[PFO], primum ASD was closed with bovine pericardial patch and PFO was closed directly. In all patient except third patient of partial ECD, mitral clefts were closed with three or four 5-0 prolene interrupted sutures. Transient A-V dissociation developed postoperatively in two patients and transient nodal rhythm developed postoperatively in other two patients. Heart failure in complete ECD with Down`s syndrome was overcome with medical treatment.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.160-164
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• 1986

Tetralogy of Fallot with absent pulmonic valve is a rare cardiac malformation. The most significant symptoms during early infancy are secondary to bronchial compression resulting from the dilated pulmonary arteries. The clinical diagnosis was confirmed by echocardiography, cardiac catheterization and cardioangiography. A case of TOF with absent pulmonic valve was successful operated upon without insertion of the pulmonic valve. The narrow pulmonic valve annulus was enlarged with a transannular pericardial patch graft. The postoperative course was uneventful.

• Journal of Chest Surgery
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• v.33 no.5
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• pp.419-421
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• 2000

Noonan syndrome is characterized by typical facies, congenital heart defect, and some clinical features similar to Turner syndrome, but with normal chromosomes. The most commonly associated cardiac defects are pulmonary valvular stenosis and strial septal defect. We experienced a case of Nonan syndrome associated with pulmonay valve stenosis with double-chambered right ventricle and atrial septal defect and cryptorchidism. Pulmonary valvotomy was done through transannular incision. Hypertrophied muscle bundles were excised. Atrial septal defect was closed directly. RVOT was reconstructed with pericardial transannular patch. Orchiopexy was performed simultaneously without any problem.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.649-655
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• 1988

One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.