Synopsis: Tetralogy of Fallot remains the most frequent cyanotic cardiac condition of the newborns. It was described for the first time in 1880 and it may seem surprising that so many questions concerning its optimal management remain unanswered up to this date.
Today our community is divided between two different approaches and two different techniques. In the transventricular technique, the VSD is closed through a ventricular incision and in the transatrial technique, the VSD is closed through the tricuspid valve. The incision in the right ventricular outflow tract is therefore smaller in the transatrial technique.
Two very different approaches are also offered to the patients. In the majority of the teams throughout the world, surgery is offered as soon as the patients present symptoms, often in neonates. And in teams like ours, surgery is delayed beyond the neonatal period, symptomatic patients having an initial systemico-pulmonary shunt. Teams favoring neonatal repair tend to adopt the transventricular technique and teams favoring the transatrial technique tend to delay the final repair beyond the neonatal period.
In the early eighties, our team has adopted and since, championed the transatrial repair. The report at the time of our outstanding early outcomes built up to this day the reputation of our centre. We have remained one of the few teams in the world to maintain a policy of repair delayed beyond the neonatal period with a consistent standard technique of transatrial repair for the last 25 years. The report of the late outcomes of the patients operated with this strategy will unveil for you whether our approach may be considered superior to a strategy of neonatal repair with the transventricular technique.
Speakers:
Dr d’Udekem lived most of his life in Belgium. He graduated surgeon in Belgium with overseas training in South Africa, Canada and the UK.
In 2003 he completed his PhD and moved to Australia to work as consultant in the Royal Children’s Hospital in Melbourne.
His research focuses on long-term outcomes after congenital heart surgery.