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Clinical Studiesof Tetralogy of Fallot Associated with Complete Atrioventricular Septal Defect

Journal of the Korean Pediatric Society 1996;39(3):354-360.
Published online March 15, 1996.
Clinical Studiesof Tetralogy of Fallot Associated with Complete Atrioventricular Septal Defect
Min Seop Song1, Chung Il Noh2, Jung Yun Choi2, 서울대학교 의과대학 소아과학교실2, Yong Jin Kim3
1Department of Pediatrics, Pusan Medical Center, Pusan, Korea
2Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
3Department of Thoracicand Cardiovascular Surgery College of Medicine, Seoul National University, Seoul, Korea
활로4징에 동반된 방실중격결손증의 임상적 고찰
송민섭1, 노정일2, 최정연2, 윤용수2, 김용진3
1부산의료원 소아과
2서울대학교 의과대학 소아과학교실
3서울대학교 의과대학 흉부외과학교실
Abstract
Purpose
: The association of the tetralogy of Fallot(TOF) with the complete form of atrioventricular septal defect(AVSD) is rare cardiac malformation.The predominant clinical findings in both groups of cases were those associated with tetralogy of Fallot, but certain features need to be emphasized, however.
Methods
: Forteen(2%) out of 659 patients with tetralogy of Fallot seen at the department of pediatrics, Seoul National University Hospital from January 1986 to June 1994, were associated with the complete form of AVSD. We reviewed clinical records, echocardiographic findings, angiographic findings and operative findings of patients. Our diagnostic criteria for TOF with complete AVSD are as follows. 1) Anterosuperior displacement of infundibular septum and RVOT obstruction. 2) Large (nonrestrictive) VSD and an overriding aorta. 3) Primum ASD with common AV valve.Goose-neck deformity of LVOT.
Results
: 1) Only 14 cases(2%) of the 659 TOF patients were associated with complete AVSD. 2) The male to female ratio was 1:2.5. 3) The predominant features were those associated with TOF, but 9 patients(64.4%) had Down's syndrome. 4) The electrocardiogram showed left axis deviation except 2 patients. 5) Most common type among 14 patients with complete AVSD defect was Rastelli type C(78.5%). 6) Associated cardiovascular anomaly included PDA, ASD of secundum type, right aortic arch, left superior vena cava. 7) Among 12 patients who underwent operations, 9 patients are still alive and followed up.
Conclusion
: TOF associated with complete AV septal defect was a rare disease. There was a clinical difference between TOF and AVSD combined groups of case. The presence of Down`s syndrome or left-axis deviation with TOF increases the likelihood of associated complete AVSD.Careful preoperative evaluation of these patient is essential to their management and successful operative treatment.
Key Words: Tetralogy of Fallot, Atrioventricular septal defect, Endocardial cushion defect


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