J.Jpn. Surg. Soc.. 80(11): 1254-1258, 1979

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Report on the annual meeting

SURTICAL CONSIDERATIONS FOR THE REPAIR OF FALLOT'S TETRALOGY

It is quite obvious that well developed collaterals in T.O.F. give many serious problems in running extracorporeal circulation during intra-cardiac repair, because a plenty of systemic blood would be drained easily to pulmonary circulation through the enormous collateral vessels and lead to poor supply of blood flow to the kidney or brain when the blood is sent to ascending aorta or femoral artery respectively.
Isolation of collateral circulation during extracorporeal circulation was intended by inflating two balloons placed in the thoracic aorta at the levels of just below of left subclavian artery and diaphragm. This technique was applied in the case who had severe cyanoses and weight over 30 Kg. Adequate perfusion to brain and kidney and relatively dry operative field were gained succussively. 61 of T.O.F. were operated in this manner. Mortality was 5.8% and no surgical death has occured in the last 30 ceases. Another surgical consideration was made for out flow reconstrucion in T.O.F.
Fascial patch for out flow tract was made in such manner as it had its own valve made from pericardium which could prevent regurgitation postopeaatively. Size of patch was dermined by prestudied plastic P-A valve model. Special intension was paid on preserving his own PA valve as much as possible such as resection of infundibulum was minimal as possible and PA valve injury was minimal as well when out flow was open.

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