Reoperation following total repair of congenital heart disease.

For the past 25 years we have performed 61 reoperations in 58 patients with congenital heart disease who previously underwent total correction for the diagnosed ventricular septal defect, tetralogy of Fallot, atrioventricular septal defect, atrial septal defect, total anomalous pulmonary venous connection (TAPVC), and other involvement for 27, 11, 5, 4, 4, and 7 patients, respectively. Causes of reoperation included 43 events of valvular lesion, 29 of residual septal defect, 5 of conduit failure, 5 of venous obstruction, 3 of hemolysis, 3 of infective endocarditis, and 2 of prosthetic valve dysfunction. Although 5 early and 4 late deaths were encountered, the remaining 49 patients (3 in New York Heart Association (NYHA) Class II and 46 in NYHA class I or II) survived the reoperation. The patients were followed up by echocardiography and chest X-ray examination, and reoperation was indicated under the following conditions: moderate to severe valvular insufficiency; residual defect causing the shunt ratio to be over 30% or a systolic pulmonary pressure over 50 mmHg; or a high pressure gradient over 50 mmHg across the right ventricular outflow tract. Early timing for reoperation seemed to be important in patients with pulmonary venous obstruction, prosthetic dysfunction, severe hemolysis and infective endocarditis.