Complete atrioventricular canal and tetralogy of Fallot: surgical management

Abstract

Between 1982 and 1989, nine patients with complete atrioventricular (AV)canal and tetralogy of Fallot underwent successful repair of bothanomalies. Seven patients had Down's syndrome. One or more previouspalliative shunts had been used in six patients. Associated cardiovascularlesions included persistent left superior vena cava (two patients), patentductus arteriosus with marked stenosis of the left pulmonary artery (onepatient). The diagnosis was confirmed by cardiac catheterization andcineangiography. Closure of the ventricular septal defect was performedthrough a combined right atrial and ventricular approach in each patient.The right ventricular outflow obstruction was relieved with the use of atransannular patch (4), right ventricular infundibular patch (4) or avalved external conduit (1). There were no hospital deaths. One patientdied as a result of meningitis 2 years after repair. Progressive left AVvalve incompetence developed in one patient requiring valve replacement. Asingle atrial approach may not provide the best exposure of the subaorticend of the defect. In this regard, we recommend an additional rightventriculotomy in order to ensure safe closure of the septal defect.Although an adequately shaped isolated patch could be sufficient to closethe anterior VSD, we favour a separate patch to minimize the possibility ofproducing subaortic obstruction. A further method to avoid this subaorticstenosis consists of dividing the common anterior leaflet to the righttowards the lateral extent of the infundibular septum.