Successful surgical correction of congenital heart disease in adults: seven years' experience.

INTRODUCTION: The long term consequences of untreated or residual/recurrent lesions pose unique challenges in the growing population of adults with congenital heart disease (CHD). This study summarizes the results of the surgical treatment of these patients. METHODS: From October 1997 to October 2004, 289 patients with CHD, aged 18-72 (35+/-13.6) years, 143 men and 146 women, presented for surgery to our unit. Thirty eight patients (13.15%) had 1 to 3 prior surgical procedures. Although 137 patients (47%) were asymptomatic (NYHA I), 117 (40.5%) had mild (NYHA II), 34 (11.7%) moderate (NYHA III) and 1 (0.3%) severe (NYHA IV) symptoms. Thirty four patients had an established arrhythmia, requiring treatment in 25 (8.6%). Chromosomal anomalies were identified in 10 (3.4%) and diagnostic catheterization was required in 178 (61.5%) patients. All patients underwent complete surgical correction and in 275 (95%) of them this was performed with cardiopulmonary bypass of 107+/-74 min mean duration. RESULTS: There was 1 early death (0.34%) due to embolic stroke related to atrial fibrillation (AF). Complications occurred in 50 patients (17%) and included re-operation for bleeding (5), stroke (3), pneumothorax (12), AF (22), complete heart block requiring permanent pacemaker implantation (2), wound dehiscence (1), pericardial (7) or pleural (3) effusion requiring drainage and peripheral neuropathy (1). Median intensive care unit and hospital stay was 1 (range 1-10) and 8 (range 5-42) days respectively. Two late deaths (0.7%) occurred in patients with AF and pulmonary hypertension. At mean follow-up of 45+/-24 (range 1-82) months all other patients are well with resolution or significant improvement in their symptoms. CONCLUSION: Despite the long term deleterious effects of CHD in adult patients, surgical correction can be achieved with low mortality and acceptable morbidity. All deaths and most significant complications are related to arrhythmias.

Surgical results after total transatrial/transpulmonary correction of tetralogy of Fallot.

INTRODUCTION: Surgical repair of tetralogy of Fallot is associated with low early morbidity and mortality. However, there may be late morbidity and mortality due to right ventricular dysfunction. The transatrial/transpulmonary technique may ameliorate these long-term complications. Here we present the results from our use of this approach. METHODS: A hundred sixty-three consecutive patients (age 6 months to 45 years, median 1.5 years) underwent transatrial/transpulmonary total correction in our department. In 142 patients the main pulmonary artery was augmented by an autologous pericardial patch, in 31 cases the arterioplasty was extended to the pulmonary artery branches, and pulmonary artery valvuloplasty was needed in 129 patients. A monocusp autologous pericardial valve mechanism was inserted in 14 patients. RESULTS: Patient follow up was 100% complete with a median duration of 3.05 years. There were no deaths. One patient required early reoperation to relieve residual right ventricular outflow tract (RVOT) obstruction. Median ICU and hospital stay were 3 and 11 days, respectively. At hospital discharge RVOT gradient was 13.7 +/- 13 (median 10) mmHg, while most patients (94%) had up to moderate pulmonary valve insufficiency (1 + in 63.8%, 2+ in 30.6%), and normal (92.6%) or mildly reduced (6.1%) right ventricular function. In 81% some degree of tricuspid regurgitation was noted. One patient required late reoperation for mitral valve repair. All patients are in NYHA class I or II. The degree of pulmonary valve insufficiency remains stable (69.9% with 0-1 + and 24.5% up to 2+). Likewise, tricuspid valve function remains unchanged (96% of the patients had mild or up to moderate regurgitation). There was no significant RVOT obstruction and in most patients (93.2%) right ventricular function was normal. CONCLUSION: These results compare very favorably to those reported in the literature. The medium-term findings auger well for future adverse event rates, but long-term follow up is still necessary to confirm them.