Long-term Results of Conotruncal Repair for Tetralogy of Fallot – 20 Years Tokyo Experiences

  • Toru Okamura, Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan
  • Takahiko Sakamoto, Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan
  • Naruhito Watanabe, Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan
  • Takuma Miyamoto, Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan
  • Takeshi Konuma, Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan
  • Masahide Komagamine, Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan
  • Toshio Nakanishi, Department of Pediatric Cardiology, Tokyo Women’s Medical University, Japan
  • Hiromi Kurosawa, Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Japan

    • Objective: Conotruncal repair for tetralogy of Fallot (TOF) was introduced in 1985 to achieve low CVP, no heart murmur, and no conduction disturbance. The purpose of this study was to evaluate the long-term results of this procedure.
    Patients and Methods: One hundred forty-three (143) TOF patients underwent conotruncal repair with hand-made monocuspid patch between October 1985 and January 1991. Patients with pulmonary atresia were excluded. The age of patients ranged from 2 months to 27 years (mean; 4.2 years).
    Results: There was no early death. Two late deaths occurred over a mean follow-up period of 17.8 years (CHF, pneumonia). There were five reoperations (residual PAPVC repair (2), pacemaker implantation for preoperative II AV block (2), residual VSD (1)). No patient required reoperation for residual outflow reconstruction and new onset AV block. Cardiac catheterization in the midterm (1 month – 5.7 years) revealed RVp of 49.5±12.9 mmHg, CVP of 9.0±2.8 mmHg, and CI of 3.8±0.9 ℓ/min/m2. In the long-term period, chest X-ray showed CTR of 51.8±4.4%, and ECG revealed PQ interval of 0.17±0.03 msec and QRS of 0.12±0.03 msec. All patients were in sinus rhythm, except for 4 patients of I AV block, and 3 of II AV block. Echocardiogram showed RV outflow pressure gradient of 16.7±9.0 mmHg, estimated RVp of 39.9±8.1 mmHg, moderate PR in 25 patients, and moderate TR in 2. All patients were in NYHA class I.
    Conclusion: Conotruncal repair for TOF has provided excellent long-term outcomes with minimum incidence of morbidity. The further careful observation is mandatory.