Abstract
In children with pulmonary atresia not amenable to initial complete correction, antegrade pulmonary blood flow can be established with surgical right ventricular outflow tract (RVOT) patch enlargement. An 11-year experience with RVOT transannular patch (TAP) augmentation without the use of cardiopulmonary bypass (off-pump) is reported. From March 1993 to October 2004, off-pump surgical RVOT enlargement with a TAP was attempted in all patients in whom a concurrent procedure that required bypass was not required. The procedure was performed with cardiopulmonary bypass standby. Twenty-two consecutive patients in whom this procedure was attempted were reviewed. Twenty of 22 patients tolerated off-pump TAP placement. In 2 patients with ductal-dependent pulmonary blood flow, off-pump TAP placement was not tolerated. Adequate antegrade pulmonary blood flow was achieved in all patients without operative mortalities or complications. There was one death in the postoperative period from myocardial ischemia secondary to right ventricular-dependent coronary circulation. Transannular RVOT patch augmentation can be performed safely and effectively without cardiopulmonary bypass.
Similar content being viewed by others
References
Agnoletti G, Piechaud JF, Bonhoeffer P, et al (2003) Perforation of the atretic pulmonary valve. J Am Coll Cardiol 41:1399–1403
Alexiou C, Mahmound H, Al-Khaddour A, et al (2001) Outcome after repair of tetralogy of Fallot in the first year of life. Ann Thorac Surg 71:494–500
Alwi M, Geetha K, Bilkis AA, et al (2000) Pulmonary atresia and intact ventricular septum percutaneous radio-assisted valvotomy and balloon dilation versus surgical valvotomy and Blalock Taussig shunt. J Am Coll Cardiol 35:468–476
Forbess JM, Visconti KJ, Hancock-Friesen C, et al (2002) Neurodevelopmental outcome after congenital heart surgery: results from an institutional registry. Circulation 106:I95–I102
Haase M, Sharma A, Fielitz A, et al (2003) On-pump coronary artery surgery versus off-pump exclusive arterial coronary grafting: a matched cohort comparison. Ann Thorac Surg 75:62–67
Ishida M, Kobayashi J, Tagusari O, et al (2002) Perioperative advantages of off-pump coronary artery bypass grafting. Circulation 66:795–799
Kirk KC, Aldridge RA, Sistino JJ, et al (2001) Coronary artery bypass grafting with and without cardiopulmonary bypass: a comparison analysis. J Extra Corpor Technol 33:86–90
Kreutzer J, Perry SB, Jonas RA, et al (1996) Tetralogy of Fallot with diminutive pulmonary arteries preoperative pulmonary valve dilation and transcatheter rehabilitation of pulmonary arteries. J Am Coll Cardiol 27:1741–1747
Murphy JG, Gersh BJ, Mair DD, et al (1993) Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 329:593–599
Parolari A, Alamanni F, Cannata A, et al (2003) Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials. Ann Thorac Surg 76:37–40
Permut LC, Laks H (1994) Surgical management of pulmonary atresia with ventricular septal defect and multiple aortopulmonary collaterals. Adv Card Surg 5:75–95
d’Udekem Y, Ovaert C, Granjean F, et al (2000) Tetralogy of Fallot: transannular and right ventricular patching equally effect late functional status. Circulation 102:III116–III122
Visconti KJ, Bichell DP, Jonas RA, Newburger JW, Bellinger DC (1999) Developmental outcome after surgical versus interventional closure of secundum atrial septal defects in children. Circulation 100:II145–II150
Wames CA (1993) Tetralogy of Fallot and pulmonaiy atresia/ventricular septal defect. Cardiol Clin 3:643–650
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Levi, D., Glotzbach, J., Williams, R. et al. Right Ventricular Outflow Tract Transannular Patch Placement without Cardiopulmonary Bypass. Pediatr Cardiol 27, 149–155 (2006). https://doi.org/10.1007/s00246-005-1110-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-005-1110-5