Transatrial approach for total correction of tetralogy of Fallot: our centre experience over three years

M. Javed Banday, Surendra V. V. B. Singh Chauhan, Manpal Loona, Dhananjay K. Bansal, Narender Singh Jhajhria, Vijay Gupta, Vijay Grover


Background: The objective of this study was to evaluate the early and mid-term outcome of total correction of tetralogy of Fallot (TOF) done through transatrial approach avoiding ventriculotomy with or without transannular patching.

Methods: Of 210 patients undergoing total correction for TOF between January 2016 and January 2019, 180 patients were operated via transatrial approach. The ventricular septal defect closure, infundibular resection and pulmonary valvotomy were performed through the right atrium. Age ranged from 12 months to 44 years (mean, 2.6 years), 104 patients were male and 76 patients were females.

Results: Three patients (1.67%) died in early post-operative period. Pulmonary complications were seen in 8 (4.44%), septicemia in 1 (0.55%), low output syndrome in 2 (1.10%) and temporary arrhythmias in 6 (3.33%) patients. Reintubation was needed in 3 (1.67%) patients. Early reoperation was needed in 3 (1.67%) patients in view of post-operative bleeding.  There were no mediastinal or deep sternal wound infections. None of our patient had complete heart block. There were no late deaths or late reoperations. Echocardiography before discharge did not reveal significant residual VSD in any patient. The mean right ventricular outflow tract pressure gradient was 28 mmHg (range of 20 to 44 mmHg) which decreased on follow-up echocardiography to 16 mmHg (range of 14 to 24 mmHg) at mean follow up of 23 months. None of our patient had severe pulmonary or tricuspid regurgitation or severe right ventricular dysfunction on follow up.

Conclusions: Transatrial repair of TOF is associated with remarkably low morbidity and mortality in our early experience.


Tetralogy of Fallot repair, Transatrial correction, Pulmonary complications

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Anderson RH, Weinberg PM. The clinical anatomy of tetralogy of Fallot. Cardiol Young. 2005;15(1):38-47.

Fallot A. Contribution to the pathological anatomy of the blue disease (cardiac cyanosis), Marseille. Med. 1888;25:77-138, 207, 270, 341, 403.

Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. J Am Med Assoc. 1945;128:189-92.

Lillehei CW, Coehn M, Warden HE, Read RC, Aust JB, DeWall RA, et al. Direct vision intracardiac surgical correction of the Tetralogy of Fallot, Pentalogy of Fallot and pulmonary atresia defects. Report of first 10 cases. Annal Surg. 1955;142(3):418-42.

Abd El, Rahman MY, Abdul-Khaliq H, Vogel M, Meskishvili VA, Gutberlet M, Lange PE, et al. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart 2000;84: 416-20.

Hudspet AS, Cordell AR, Meredith JH, Johnston FR. An improved Transatrial approach to closure of ventricular septal defects. J Thoracic Cardiovas Surg. 1962;43:157-65.

Edmunds LH, Saxena NG, Friedman S, Rashkind WJ, Dodd PF. Transatrial repair of tetralogy of Fallot. J Paedia Surg. 1976;80:681-8.

Banday MJ, Jhajhria NS, Grover V, Gupta V, Surendra VVSC, Bansal D, et al. Jhajhria infundibular resection adequacy assessment techinique (JIRAAT) to assess the adequacy of right ventricular outflow tract muscle bands resection. J Med Sci Clin Res. 2019;07:996-8.

Stirling GR, Stanley PH, Lillehei CW. The effects of cardiac bypass and ventriculomy upon right ventricular function. Surgery Forum. 1957;8:433-8.

d’Udekem Y, Ovaert C, Grand JF, Garin V, Cailteux PS,Vliers A, et al. Tetralogy of Fallot: transannular and right ventricular patching equally affect late functional status. Circulation. 2000;102(Suppl 3):116-22.

Dietl CA, Torres AR, Cazzaniga ME, Favaloro RG. Right atrial approach for surgical correction of tetrology of Fallot. Annals of Thoracic Surgery. 1989;47:546-52.

Pacifico AD, Sand ME, Bargeron LM, Colvin EC. Transatrial transpulmonary repair of tetrology of Fallot. Thoraic Cardiovas Surg. 1987;93:919-24.

Giannopoulos NM, Chatzis AK, Karrros P, Zavaropoulos P, Papagiannis J, Rammos S, et al. Early results after transatrial/ transpulmonary repair of tetralogy of Fallot. European J Cardiothorac Surg. 2002;22:582-6.

Murphy JG, Gersh BJ, Mair DD, Fuster V, McGoon MD, Ilstrup DM, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. The New England Journal of Medicine. 1993;329(9):593-9.

Airan B, Choudhary SK, Kumar HV, Talwar S, Dhareshwar J, Juneja R, et al. Total Transatrial Correction of Tetralogy of Fallot: No Outflow Patch Technique. Annal Thoracic Surg. 2006;82:1316-21.

Kawashima Y, Kitamura S, Nakanu S, Yagihara T. Corrective surgery of tetralogy of Fallot without or with minimal right ventriculotomy and with repair of the pulmonary valve. J Pediatric Surg. 1981;64(2):147-53.

Stewart RD, Backer CL, Young L, Mavroudis C. Tetralogy of Fallot: Results of a pulmonary valve-sparing strategy. Annal Thorac Surg. 2005;80:1431-9.

Kaushal SK, Radhakrishanan S, Dagar KS, Iyer PU, Girotra S, Shrivastavs S, et al. Siginificant intraoperative right ventricular outflow gradients after repair for tetralogy of Fallot: to revise or not to revise? Ann Thorac Surg. 1989;48:783-91.

Rowlatt JF, Rimoldi HJ, Lev M. The quantitative anatomy of the normal child's heart. Pediatr Clinics North Am. 1963;10:499-588.

Voges I, Fischer G, Jens S, Shumacher M, Sonya V, Narayan B, et al. Restrictive enlargement of the pulmonary annulus at surgical repair of tetralogy of Fallot: 10-year experience with a uniform surgical strategy. European J Cardio-thoracic Surg. 2008;34:1041-5.