The Taussig-Bing anomaly: long-term results.

OBJECTIVES: The arterial switch operation (ASO) is the method of choice for the Taussig-Bing heart. The aim of the study was to analyse the long-term outcome of correction of the Taussig-Bing heart. METHODS: Between 1986 and 2011, 44 infants, including 18 newborns, underwent an ASO. The staged and the primary approach were used in 9 and 35 patients, respectively. Aortic arch (AA) obstruction (n = 26) and right ventricle outflow tract obstruction (n = 34) were common. The mean age at corrective surgery was 112.9 days; the mean weight was 4.17 kg. RESULTS: There were 1 early and 4 late deaths. Overall survival was 88% at 15 years, with a mean follow-up of 9.2 years. Freedom from reoperation was 67% at 15 years of follow-up. Eight and 6 patients required right and left ventricular outflow tract surgery, respectively, including resection of the right ventricular outflow tract obstruction (n = 8), a transanular patch (n = 6), aortic valve reconstruction (n = 3), aortic valve replacement (n = 2) and AA reoperation (n = 4). Freedom from aortic regurgitation >mild or aortic valve replacement/reconstruction was 76% at 15 years of follow-up. Freedom from any event was 56% at 15 years of follow-up. All patients are in sinus rhythm, and biventricular function is well-preserved in 95% of patients. All patients are doing well; 86% of them are without medication. CONCLUSIONS: Corrective surgery offers excellent survival benefits and encouraging long-term functional outcomes, regardless of the coronary anatomy and associated lesions. Normal biventricular function is preserved in the vast majority of patients, and >3/4 of patients are without cardiac medication. Nevertheless, TBH associated with a complex anatomy continues to be a risk factor for long-term morbidity, and redos and reinterventions are equally common on both outflow tracts. Progressive neoaortic regurgitation and neoaortic root dilatation might be a problem in the future; therefore, close lifelong surveillance of patients is necessary.

Is there any need for a shunt in the treatment of tetralogy of Fallot with one source of pulmonary blood flow?

OBJECTIVES: In symptomatic patients, performing a primary repair of tetralogy of Fallot (TOF), irrespective of age or placing a shunt, remains controversial. The aim of the study was to analyse the policy of primary correction. METHODS: Between May 2005 and May 2012, a total of 87 consecutive patients with TOF, younger than 6 months of age, underwent primary correction. All patients had one source of pulmonary blood flow, with or without a patent ductus arteriosus. The median age at surgery was 106 ± 52.3 days (8-180 days). Twelve patients (13.8%) were newborns. Two groups were analysed: group I, patients <1 month of age; group II, patients between 2-6 months of age. RESULTS: There was no early or late death at 7 years of follow-up. There was no difference in bypass time or hospital stay between the two groups, but the Aristotle comprehensive score (P < 0.0001), ICU stay (P = 0.030) and the length of ventilation (P = 0.014) were significantly different. Freedom from reoperation was 87.3 ± 4.3% and freedom from reintervention was 85.9 ± 4.2% at 7 years, with no difference between the two groups. Neurological development was normal in all patients, but 1 patient in Group II had cerebral seizures and showed developmental delay. Growth was adequate in all patients, except those with additional severe non-cardiac malformations that caused developmental delay. Eighty-five per cent of the patients were without cardiac medication. CONCLUSIONS: Even in symptomatic neonates and infants <6 months of age, primary repair of TOF can be performed safely and effectively. One hundred per cent survival at 7 years suggests that early primary repair causes no increase in mortality in the modern era. Shunting is not necessary, even in symptomatic newborns, thus avoiding the risk of shunt-related complications and repeated hospital stays associated with a staged approach.

A novel approach to the repair of tetralogy of Fallot with absent pulmonary valve and the reduction of airway compression by the pulmonary artery.

Controversy persists regarding the management of patients suffering from tetralogy of Fallot with absent pulmonary valve syndrome. Airway obstruction caused by the dilated pulmonary arteries is the determining factor in the mortality of symptomatic newborns and infants. A number of surgical techniques for the reduction of bronchial obstruction have been proposed, producing variable results. All strategies have focused on plication and reduction of the anterior or posterior wall of the normally positioned pulmonary arteries, with or without pulmonary valve replacement. An alternative approach is to bring the pulmonary arteries anterior to the aorta and away from the trachea and bronchial tree. This technique has the potential to reduce or eliminate bronchial compression by the central pulmonary arteries. Failure of the treatment could be expected in symptomatic patients, where the pathology of the airways extends beyond the proximal pulmonary arteries.