Tetralogy of Fallot repair in patients presenting after Infancy: a single surgeon experience

Objective: To determine the early surgical outcomes of Tetralogy of Fallot [TOP] repair in children and young adults operated after the age of one year

Methods: In this retrospective study, 307 cases of primary repair of Tetralogy of Fallot were done between September 2012 to February 2017, at CPE Institute of cardiology, Multan. Out of 307 operated patients, 4 [1.3%] patients had previous modified Blalock Taussig shunts, 2 [0.6%] associated ASD with TOF, 3 [0.9%] co-association of TOF with PDA, 2 [0.6%] had large conal arterial branch crossing the annulus, 3 [0.9%] had dextrocardia with situs inversus, 12 [3.9%] TOF with double outlet right ventricle [DORV], 2 [0.6%] were associated with complete AV canal defect, 8 [2.60%] with absent pulmonary valve syndrome, 15 [5.5%] I with left pulmonary artery stenosis. Data of post-operative complications and operative parameters was recorded for all patients

Results: Mean age of operated patients was 9.56+/-4.89 years. Post-operative complications occurred in 7.8% of patients. Most common post-operative complications were pleural effusion with a frequency of 12[3.9%] patients, and complete heart block in one patient. Insignificant small residual VSD was diagnosed in 8 [2.6%] patients. One moderately large VSD was closed surgically after one year of 1st surgery. Moderate to severe pulmonary valve regurgitation was diagnosed in 114 [37.1%] patients. Mild to moderate tricuspid regurgitation in 15 [4.8%] patients and moderate right ventricular outflow tract obstruction [RVOT] in 16 [5.2%] patients. Thirty-day mortality was only four [1.3%]

Conclusion: Surgical correction of Tetralogy of Fallot [TOF] in children after one year carries good operative outcomes with minimum morbidity and mortality

Surgical repair of partial atrioventricular septal defect

Objective: To review the results of surgical correction of partial atrioventricular septal defect and associated cardiac comorbidities

Methods: Retrospective case analysis of electronic database of department of paediatrics cardiac surgery, CPEIC, Multan was done. Forty consecutive patients operated for partial atrioventricular septal defect repair from September 2011 to October 2016 were included. Mean age was 14.67+/-7.96 years. 60% [24] patients were male. Regarding echocardiographic findings, pre-operatively 40% [n=16] had mild, 47.5% [19] had moderate and 12.5% [n=5] had severe mitral valve regurgitation. There were 25% [n=10] patients having moderate tricuspid valve regurgitation. Pulmonary hypertension was moderate in 57.5% [n=23] cases and severe in 7.5% [n=3] cases. Among other associated lesions 10% [n=4] patients had secundum ASD, pulmonary artery stenosis was seen in 5% [n=2] patients. Another 5.0% [n=2] patients had bilateral SVCS. While one patient had PDA and one patient had associated common atrium

Results: Post-operatively there were 19 cases [47.5%] having no mitral valve regurgitation while 18 [45%] patients showed mild and 7.5% [n=3] had moderate mitral valve regurgitation. Only one case had moderate tricuspid valve regurgitation post-operatively, while 22.5% [n=9] cases had mild tricuspid regurgitation. Complete heart block and left sided brain infarct developed in one case. There was no mortality, reoperation, residual atrial shunt or left ventricular outflow tract obstruction

Conclusion: Repair of partial AV canal carries good overall results with minimal mortality however earlier repair is suggested to reduce post- operative morbidity further