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Tetralogy of Fallot: Transventricular Repair, Including Pulmonary Atresia Without MAPCAs

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Surgery of Conotruncal Anomalies

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Abstract

Timing and indications of surgical techniques in patients with Tetralogy of Fallot (TOF) remains controversial nowadays. The ideal timing for surgical repair of asymptomatic patients seems to be between 3 and 6–9 months. Severe persistent hypoxemia in neonates constitute an absolute indication to a surgical intervention, managed either by an aorto-pulmonary shunt or by a neonatal complete repair. The surgical techniques described in this chapter focus on all the techniques described to repair a TOF through the right ventricle, with a specific interest in the valve-sparing transventricular repair technique which can include pulmonary valve thinning, commissurotomy, intraoperative balloon dilation, or a patch augmentation of the pulmonary valve. The right ventricle-pulmonary artery connection using a transannular patch in patients with TOF with pulmonary atresia is also described. In contemporary practice, repair of TOF has become a safe procedure with excellent outcomes.

This chapter will focus on the surgical transventricular repair of Tetralogy of Fallot (TOF), including pulmonary atresia (PA) without MAPCAs. The transatrial repair, the palliation with a BT-shunt, the redo surgery and the repair of TOF-PA with main aortopulmonary collateral arteries (MAPCAs), TOF-AVSD and absent pulmonary valve syndrome are treated in other chapters. The valve-sparing transventricular repair technique will be emphasized.

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Authors and Affiliations

  1. Division of Cardiac, Thoracic, and Vascular Surgery/Pediatric and Congenital Cardiac Surgery, New York Presbyterian-Columbia University Medical Center/Combined Morgan Stanley Children’s Hospital of New York (CHONY) – Komansky Weill-Cornell Program, 3959 Broadway, CHN 274, New York, NY, 10032, USA

    David Kalfa MD, PhD, Paul J. Chai MD & Emile Bacha MD, FACS

Authors
  1. David Kalfa MD, PhD
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  2. Paul J. Chai MD
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  3. Emile Bacha MD, FACS
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Correspondence to Emile Bacha MD, FACS .

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Editors and Affiliations

  1. Royal Brompton Hospital, London, United Kingdom

    Francois Lacour-Gayet

  2. C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA

    Edward L. Bove

  3. German Pediatric Heart Center, Asklepios Klinik Sankt Augustin Gmb, Sankt Augustin, Germany

    Viktor Hraška

  4. University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA

    Victor O. Morell

  5. Department of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Thomas L. Spray

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Kalfa, D., Chai, P.J., Bacha, E. (2016). Tetralogy of Fallot: Transventricular Repair, Including Pulmonary Atresia Without MAPCAs. In: Lacour-Gayet, F., Bove, E., Hraška, V., Morell, V., Spray, T. (eds) Surgery of Conotruncal Anomalies. Springer, Cham. https://doi.org/10.1007/978-3-319-23057-3_5

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  • DOI: https://doi.org/10.1007/978-3-319-23057-3_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23056-6

  • Online ISBN: 978-3-319-23057-3

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