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DOI: 10.1055/s-2007-1022071
Surgical Problems in Total Correction of Tetralogy of Fallot after Primary Palliation
Publication History
1979
Publication Date:
19 March 2008 (online)
Summary
The surgical problems in total correction of tetralogy of Fallot following palliation encountered in 65 patients after construction of Waterston-Cooley (33) and Blalock-Taussig (32) anastomoses are presented. The Waterston-Cooley shunt was severely angulated in 9 patients, causing underperfusion or occlusion of the left pulmonary artery. Pulmonary hypertension was present in 3 patients with increased vascular resistance in one. The Blalock-Taussig anastomosis was obliterated in 9 patients, caused complete occlusion of the right pulmonary artery in one and formation of an aneurysm of the subclavian artery at the site of the anastomosis in one. Transannular patching of the right ventricular outflow tract was necessary in 95 % of the patients palliated in the first year of life. As some degree of angulation of the Waterston-Cooley anastomosis was seen in almost 60% of the patients, we have abandoned its transaortic closure technique. The right pulmonary artery is now dissected from the aorta and both the aorta and pulmonary artery are sutured separately. The operative mortality rate was 16.9 % and is markedly higher than in our non-palliated patients undergoing correction of tetralogy of Fallot. Two early and one late death must be attributed to the previous shunt procedure.
With regard to the high incidence of complications and failures of the aortopulmonary shunts, we conclude that their application should be restricted to symptomatic babies with a hypoplastic pulmonary valve and annulus requiring early surgical intervention because of severe hypoxemia.
Key words
Tetralogy of Fallot - Staged repair - Complications of Waterston-Cooley anastomosis - Complications of Blalock-Taussig anastomosis