PMID- 14529985
OWN - NLM
STAT- MEDLINE
DCOM- 20031120
LR  - 20190628
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 76
IP  - 4
DP  - 2003 Oct
TI  - Tetralogy of Fallot with subarterial ventricular septal defect.
PG  - 1059-64; discussion 1064-5
AB  - BACKGROUND: Tetralogy of Fallot with subarterial ventricular septal defect is 
      frequently seen among Asians. Compared with infracristal ventricular septal 
      defect, postoperative right ventricular outflow obstruction is more likely 
      because of subpulmonary extension of the defect. Moreover the incidence of aortic 
      regurgitation is a concern because of the absence of a supporting infundibulum. 
      METHODS: Four hundred cases of classic tetralogy were reviewed, 61 of which had 
      subarterial ventricular septal defect. RESULTS: Aortic regurgitation (of more 
      than mild degree) was identified in 7 cases with subarterial and 7 with 
      infracristal ventricular septal defects. The mechanism of infracristal defect was 
      predominantly an annular dilation before surgery. In contrast 5 cases with 
      subarterial defect had progression of aortic regurgitation after operation 
      yielding an actuarial incidence of 29.7% at 20 years. In 2 patients the cause 
      seemed to be fixation or plication of the aortic valve annulus by the ventricular 
      septal patch. Compared with infracristal defect, subarterial defect was 
      associated with increased incidence of reoperation (12.0% versus 1.9% at 10 
      years, p = 0.01), frequent use of transannular patch (70.5% versus 45.7%, p = 
      0.0004), and worse New York Heart Association (NYHA) functional class (p = 
      0.007). Right ventricular outflow obstruction was the reason for reoperation in 3 
      patients with subarterial defect and was associated with worse NYHA 
      classification in the long-term, on multivariate analysis (p = 0.0002). 
      CONCLUSIONS: Tetralogy with subarterial ventricular septal defect was associated 
      with worse functional outcome. To prevent adverse outcomes, precise suturing of 
      the distal ventricular septal patch, extensive infundibulectomy, lower threshold 
      for transannular incision, and smaller-sized ventricular septal patch placement 
      are warranted.
FAU - Ando, Makoto
AU  - Ando M
AD  - Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, Tokyo, 
      Japan. maando@shi.heart.or.jp
FAU - Takahashi, Yukihiro
AU  - Takahashi Y
FAU - Kikuchi, Toshio
AU  - Kikuchi T
FAU - Tatsuno, Katsuhiko
AU  - Tatsuno K
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Aortic Valve/surgery
MH  - Aortic Valve Insufficiency/etiology
MH  - Child
MH  - Female
MH  - Heart Septal Defects, Ventricular/*complications/surgery
MH  - Humans
MH  - Male
MH  - Reoperation
MH  - Retrospective Studies
MH  - Tetralogy of Fallot/*complications/surgery
EDAT- 2003/10/08 05:00
MHDA- 2003/12/03 05:00
CRDT- 2003/10/08 05:00
PHST- 2003/10/08 05:00 [pubmed]
PHST- 2003/12/03 05:00 [medline]
PHST- 2003/10/08 05:00 [entrez]
AID - S0003497503008361 [pii]
AID - 10.1016/s0003-4975(03)00836-1 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2003 Oct;76(4):1059-64; discussion 1064-5. doi: 
      10.1016/s0003-4975(03)00836-1.