Total intra-cardiac repair of cyanotic congenital heart disease in Accra 20 years experience

Objective: To analyse the spectrum of cyanotic congenital heart disease that had total intra-cardiac repair in this Centre and the outcome over a 20-year period. Patients and Methods: A retrospective study was done for all patients who had intra-cardiac repair for cyanotic congenital heart disease from January 1992 to December 2011. Results: There were 115 cases, with 56.5% of them being male. The modal age group was 5 – 9 years (45.2%), with a mean of 8.5 ± 5.3 years. Tetralogy of Fallot (TOF) comprised the majority of cases (n=108; 93,1%), with double outlet right ventricle (DORV) forming the remaining 7 cases (6,9%). Most of the TOFs, 78 (72.2%) needed palliation with a Modified Blalock-Taussig Shunt (MBTS), whilst the remaining 30 (27.8%) had primary correction. The mean duration of an MBTS before total repair was 2.3 years. Ten (9.3%) of the TOF patients had bilateral MBTS due to occlusion of the first shunts. The overall complication rate was 19.1% (22 cases). This was due to bleeding requiring re-exploration in one patient (0.9%), acute renal failure (ARF) requiring dialysis (n=1; 0,9%), complete heart block requiring permanent pacemaker implantation (n=4; 3,4%) and the 30-day mortality of 16 patients (13,9%). Conclusion: Presently, total intra-cardiac repair is the logical conclusion in the management of most cyanotic congenital heart diseases. Excellent long-term survival following total repair has been reported in many studies. This study revealed acceptable complication rates and a good outcome. Keywords: Intra-cardiac repair, cyanotic, congenital heart disease