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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.
RESUMO
<p>For A 38-year-old male diagnosed a congenital complete atrioventricular block in the neonatal period, epicardial lead and pacemaker was implanted through left thoracotomy. Although we tried to implant a pacemaker through the subclavian vein as an adult, it was unsuccessful because of obstruction of the bilateral subclavian vein. For this reason, we performed a pacemaker implantation with transatrial-endocardial lead through the right thoracotomy due to save the generator electric power. This is one of the useful techniques for cases with obstruction of the upper extremity vein.</p>
RESUMO
La trombosis de la vena cava superior es infrecuente, pero su aparición dificulta la vía de acceso para el implante de marcapasos y desfibriladores. Existen alternativas cuando no se puede utilizar la vía endovascular y la vía epicárdica es la de elección. Sin embargo, se describieron implantes de catéteres de desfibrilador por vía transauricular por toracotomía mínima con buenos resultados a largo plazo y con el logro de un umbral de desfibrilación adecuado. En esta presentación se describe el caso de un paciente con antecedentes de cardiopatía chagásica e implante de un marcapasos bicameral por enfermedad binodal que necesita un desfibrilador. Debido a que se trata de un paciente joven con accesos dificultosos se decidió utilizar la vía transauricular por toracotomía mínima conservando el catéter auricular para estimulación y sensado.
Thrombosis of the superior vena cava is an infrequent condition; yet, its presence prohibits placement of pacemakers and defibrillator devices. The epicardial approach is indicated when the venous access for lead placement is compromised. However, implantable cardioverter device placement using minithoracotomy has been described with favorable long-term outcomes, achieving an adequate defibrillation threshold. We describe the case of a patient with a history of Chagas cardiomyopathy and dual-chamber pacemaker placement due to coexisting sinus node and atrioventricular node dysfunction. We decided to use the transatrial approach via minithoracotomy leaving the atrial lead for sensing electrical activity and delivering stimulation pulses.