Objective: Because of the left-sided location of the main atrioventricular conduction axis, the membranous flap can be safely used for closure of the ventricular septal defect in tetralogy of Fallot. Methods: Conotruncal repair consists of (1) precise closure of the defect using the membranous flap and (2) outflow reconstruction of the right ventricle by a wide monocusp patch. This method has been followed in 233 patients from October 1985 to March 1997. The age of patients ranged from 2 months to 53 years, with a mean of 4.6 years; 44% were younger than 2 years of age, and 11% were less than 12 months of age. Results: A membranous flap was present in 86%, 12% had a muscle bar between the defect and the tricuspid valve, and only 2% had neither a membranous flap nor a muscle bar. There was no early death; two late deaths occurred over a mean follow-up period of 7.3 years. The actuarial survival was 99.1%. No patients required reoperation except for two with residual anomalously connecting pulmonary veins. All 233 patients were in sinus rhythm postoperatively. No patient has had a significant residual defect. The mobility of the polytetrafluoroethylene monocusp was echocardiographically detected in 85% and pulmonary regurgitation was less than mild in 82% at the late phase. The late right and left ventricular pressure ratio was 0.40 ± 0.14 (n = 30) and the late central venous pressure was 5.6 ± 2.2 mm Hg (n = 30). Conclusion: Conotruncal repair has provided good midterm results with a low central venous pressure, well-reconstructed outflow tract of the right ventricle, no residual defect, and no heart block.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine