Transatrial Approach to Total Correction of Tetralogy of Fallot

A transatrial approach to total correction of the tetralogy of Fallot is presented which utilizes: (1) anteroposterior incision of the right atrium near the right atrioventricular groove; (2) circumferential detachment of the septal leaflet of the tricuspid valve near the annulus; (3) pulmonary arteriotomy with valvuloplasty, if necessary; (4) retrograde displacement and resection of the stenosed infundibulum through the right atrium; (5) closure of the ventricular septal defect; (6) closure of the incision in the tricuspid valve; and (7) closure of the atriotomy. Clinical application to 10 consecutive patients, varying from acyanotia to severely cyanotic, has confirmed the advantages and simplicity of this method. Coronary arterial division, ventriculotomy, and external enlargement of the pulmonary outflow tract have been unnecessary. Relief of pulmonary stenosis has been adequate in each instance. The ventricular septal defect has been well exposed in each patient, and its closure has presented no special problem. There have been no complications associated with the method, and postoperative cardiac function has been good. Operative as well as clinical features of the method are still under investigation; however, experience thus far has led to its establishment as a routine for total correction of the tetralogy of Fallot in this clinic.