Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. It is characterized by an interventricular communication with an overriding aorta, subpulmonary obstruction, and consequent right ventricular hypertrophy. The potential for late complications is an important concern for growing number of survivors after surgical repair, although long-term survival rates are excellent. Progressive pulmonary valve regurgitation leading to right heart failure and arrhythmias are common late complications and major reasons of mortality. In this review, we focus on research progress of pathogenesis and treatment of late complications after TOF repair, and the importance of long-term follow-up is emphasized.
Objective To improve the operative effects of patients who had tetralogy of Fallot with aortopulmonary collateral arteries (TOF-APCAs) and evaluate the clinical effects of staging and onestop hybrid approach for TOFAPCAs. Methods From January 2003 to December 2007, thirty patients with TOF-APCAs had undergone combined therapy of APCAs embolization and complete surgical repair. Fifteen patients had APCAs embolization therapy before or after TOF radical operation(staging hybrid group ); Fifteen had onestop hybrid treatment(onestop hybrid group). Results Angiography revealed that there were 19 APCAs in staging hybrid group, and of which 15(78％) were embolized successfully. Five cases had complications and one died from respiratory circulating failure. The rest all recovered and discharged. And 22 APCAs were found in one-stop hybrid group, eighteen (82％) of them were embolized successfully. Only one case had pulmonary effusion. The time of hospitalization(median 37 d vs. 22 d, P=0.011),ICU staying（median 7.0 d vs. 4.7 d,P=0.029）and endotracheal intubation（median 131 h vs. 19 h,P=0.009） was obviously longer, and the hospitalization expenses（median 64 101 [CM(159mm]yuan vs. 48 021 yuan, P=0.033）were obviously higher in staging hybrid group than that in one-stop hybrid group.And there was no statistical significance in cardiopulmonary bypass time（P=0.126） and aortic clamping time（P=0.174） between two groups. Conclusion In comparison with traditional staging hybrid approach, one-stop hybrid approach can simplify the operative process for patients who have TOFAPCAs, improve the operative successful rate and cut down expenses.
ObjectiveTo analyze the clinical effects of staged repair for severe tetralogy of Fallot (TOF), and to investigate a better individual treatment of TOF. MethodsWe retrospectively analyzed the clinical data of 110 children with TOF in our hospital from January 2009 through December 2014. The patients were divided into a severe TOF group (Group A, n=23) and a mild TOF group (Group B, n=87). In the group A, all 23 patients underwent staged surgery (modified Blalock-Taussig and radical operation of TOF). In the Group B, all 87 patients only received a radical operation of TOF. The patients' preoperative and postoperative arterial oxygen saturation, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), the results of perioperation and follow-up were compared. ResultsIn the group A, there was no death after modified Blalock-Taussig (MBT). The median interval time between MBTs and radical operation was 9 months (ranged from 6.3 to 25.3 months). Compared with that before MBTs, the McGoon ratio and LVEDVI were significantly increased at the time of radical operation. And the pulmonary artery development and left ventricle volume reached the standard of radical operation of TOF (P < 0.01). After the radical operation, one patient died for pneumonia in the early postoperation period. In the group B, three patients died for low cardiac output syndrome during perioperation. There was no significant difference between the group A and the group B in in-hospital mortality, length of hospital stay, intensive care unit (ICU) stay, ventilation time, cardiopulmonary bypass time, aortic cross-clamp time, rate of using trans-annular repair path, or drainage of pleural fluid. ConclusionStaged repair of severe TOF is safe and effective for children, who are not suitable for one-stage radical operation. Severe TOF received staged repair can achieve the similar outcomes with that of mild TOF underwent one-stage radical operation.
Objective To summarize the experience of surgical correction of complete atrioventricular septal defect associated with tetralogy of Fallot(CAVSD-TOF). Methods Twelve patients aged 6-16(11.1±2.8) years underwent correction of CAVSD-TOF. The atrioventricular septal defect was closed through a right atriotomy and longitudinal right ventriculotomy in each case. The three-patch technique was used for the first 7 cases and two-patch technique for the later 5 cases. The commissure between the superior and inferior bridging leaflets of the left portion of the common atrioventricular valve was closed in each patient. Right ventricular outflow tract obstruction was relieved by a transannular patch. Results There were 4 deaths in the early postoperative period, 3 deaths in the first 7 cases compared to 1 death in the later 5 cases. The causes of death included severe low cardiac output syndrome(3 cases) and perfusion pulmonary edema(1 case). Six survivors were followed up from 3 months to 13.5 years. Heart function (NYHA) was class I or Ⅱ in all cases. Conclusion CAVSD-TOF can be corrected by using the two-patch technique and closure of atrioventricular septal defect through a combined approach through right atriotomy and right ventriculotomy. Routine closure of the commissure of the left portion of the atrioventricular valve achieves a low incidence of regurgitation.
Objective To summarize the immediate and intermediate outcomes of surgical correction on patients with tetralogy of Fallot and absent pulmonary valve (TOF/PVAB). Methods From January 1996 to August 2009, 14 patients，including 5 males and 9 females, aged 3.4±3.4 years (0.2-11.0 years) with an average weight of 12.0±6.3 kg (4-26 kg), underwent complete surgical correction in Beijing Fu Wai Cardiovascular Hospital. The right ventricular outflow tract was reconstructed with valved conduit in 4 patients, and monocusp with transannular patch was used in 10 patients. Six patients underwent pulmonary artery wall reduction, and 2 patients underwent both pulmonary artery plication and wall reduction. Results There were 2 (14.3%) perioperative deaths. Both were low bodyweight infants. One died of low cardiac output and respiratory failure, and the other died of central nervous system complications. Ten patients were followed up for an average time of 8.3±4.3 years (0.6-13.0 years). All patients followed up survived. The echocardiogram found pulmonary valvular dysfunction in 4 patients. The patients’ cardiac function were classified as New York Heart Association(NYHA) Ⅰ to Ⅱ. There was no late death or reoperation. Conclusion The immediate and intermediate outcomes of surgical correction of TOF/PVAB are good, but the function of pulmonary valves and conduit should be followed-up closely.
Objective To compare the clinical effect of three operations for one-stage radical correction of small left ventricle in children with tetralogy of Fallot (TOF). Methods We retrospectively analyzed the clinical data of 120 patients with left ventricular dysplasia and TOF undergoing one-stage radical surgery in the First Hospital of Hebei Medical University from December 2004 to May 2017. According to the different types of operation used, they were divided into 3 groups, including a routine group (30 patients, 16 males and 14 females, aged 11.58±2.05 months ranging from 3-24 months), a large patch group (40 patients, 22 males, 18 females, aged 11.22±2.24 months ranging from 3-25 months) who were treated with a large patch, and an enlarged ventricular septal defect group (50 patients, 26 males, 24 females, aged 10.17±2.15 months ranging from 3-22 months) using new left ventricular enlargement technique to enlarge ventricular septal defect. The clinical effect of the three operations were compared. Results The incidence of postoperative low cardiac output syndrome (6.0% vs. 40.0%vs. 50.0%, P<0.05), renal failure (4.0%vs. 37.5% vs.46.7%, P<0.05), infection rate (10.0%vs. 50.0% vs.66.7%, P<0.05), mortality (2.0%vs. 12.5% vs. 20.0%, P<0.05), ventilator-assisted time (8.34±5.24 hvs. 36.14±10.91 h vs. 38.58±10.12 h, P<0.05), ICU stay (4.13±1.01 dvs. 7.64±2.11 d vs.8.03±3.03 d, P<0.05), hospital stay (10.48±4.26 dvs. 21.02±3.23 d vs. 22.52±2.93 d, P<0.05) and hospitalization costs (51 300±9 400 yuanvs.103 200±39 300 yuan vs. 115 500±35 200 yuan, P<0.05) were less in the enlarged ventricular septal defect group compared with the other two groups. Conclusion The clinical effect of enlarged ventricular septal defect is better than that of the routine and large patch methods, and long-term efficacy should be further followed up.
ObjectiveTo compare short-term outcomes of radical correction of tetralogy of Fallot (TOF)with or without transcatheter embolization of major aortopulmonary collaterals (APC). MethodsClinical data of 58 TOF patients undergoing radical correction from January 2008 to June 2013 in the Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 36 male and 22 female patients. Among them, 22 patients (Group A, 12 males and 10 females)received radical TOF correction combined with transcatheter embolization of major APC, and 36 patients (Group B, 24 males and 12 females)received radical TOF correction alone. Average age of group A was (24.91±6.77)years and that of group B was (22.42±5.06)years. Aortic cross-clamping time, ICU stay, postoperative hospital stay, left ventricular ejection fraction (LVEF)7 days and 3 months after the operation were compared between the 2 groups. ResultsThere was no in-hospital death. There was no statistical difference in sex, age, preoperative McGoon ratio or hemoglobin (Hb)levels between the 2 groups (P > 0.05). Aortic cross-clamping time[ (43.87±13.02)minutes vs. (53.60±11.69)minutes, P < 0.05], ICU stay[ (26.09±4.84)hours vs. (28.87±4.38)hours, P < 0.05] and postoperative hospital stay[ (12.32±1.81)days vs. (13.67±2.14)days, P < 0.05] of group A were significantly shorter than those of group B. LVEF 7 days after the operation of group A was significantly higher than that of group B (56.64%±8.19% vs. 52.58%±5.62%, P < 0.05), and there was no statistical difference in LVEF 3 months after the operation between the 2 groups (58.50%±8.78% vs. 55.42%±6.18%, P > 0.05). ConclusionFor surgical treatment of TOF, compared with radical correction alone, radical correction combined with transcatheter embolization of major APC can significantly shorten aortic cross-clamping time and improve postoperative heart function recovery.
Abstract: Objective To evaluate the results of surgical treatment of tetralogy of Fallot in adults． Methods From July 2002 to August 2009，75 adult patients with tetralogy of Fallot received surgical treatment in Xijing Hospital, ForthMilitary Medical University．There were 35 males and 40 females, with age at l7 to 37 years (23.30±3.50 years), and eoperativehemoglobin at 143 to 231 g/L(172.00±31.00 g/L)．All these patients were diagnosed by.echocardiograph before operation. All the patients were received tetralogy of Fallot of corrective operation in the hypothermia cardiopulmonary bypass. A total of 46 patients had a transannular right ventricular outflow tract patch，and 29 patients had a non ansannular patch． Results Operation time was 157 to 276 min(221.32±41.34 min), cardiopulmonary bypass time was 68 to 163 min(91.71±28.35 min) and aorta intercepted time was 37 to 96 min（55.47±23.61 min）. There were 6 operative deaths with an operative mortality at 8.00％. The causes of death were low output syndrome(n=3)，acute renal failure(n=2)， and multiple organ failure(n=1)．Nine patients needed reoperation for postoperative bleeding(12.00％)．We followed up 69 patients from 3 to 56 months (26.31±7.40 months). There were 2 patients with trivial residual shunt. The cardiac function status were New York Heart Association(NYHA) Ⅰ to Ⅱ in the 69 patients．No late death occured． Conclusion The effectiveness of surgical treatment for adults with tetralogy of Fallot is satisfactory．
Abstract： Objective To summarize our surgical experience of tetralogy of Fallot（TOF） with anomalous coronary artery（ACA）， explore diagnostic method of ACA， and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract（RVOT） reconstruction. Methods From January 2004 to January 2010， 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years （5 months to 33 years）and median body weight of 18 （5 to 51） kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement， repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation （REV） technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above， below or beside coronary arteries （single patch or two patch technique）. Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results The median cardiopulmonary bypass time was 78 （65-102） min， median aortic crossclamp time was 50（40-82） min， and median operation time was 150 （126-178） min. There was no early death or severe coronary artery injury. Two patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 （21-83）months and there was no late death during follow-up. All the patients were in New York Heart Association （NYHA） classⅠduring follow-up， their left ventricular ejection fraction was normal， there was no sign of myocardial ischemia in electrocardiogram， and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient （△P） was 19 （8-38） mm Hg， and the RVOT gradient （△P） did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography （64-MSCT）. Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.
Abstract： With the evolvement of surgical, anesthetic, perfusion, and perioperative management techniques, the mortality of routine corrective operation of tetralogy of Fallot（TOF） has been less than 2%-3%, while more and more attention has been paid to patient long-term prognosis. Chronic postoperative pulmonary regurgitation （PR） is one of the important prognostic factors which are puzzling cardiac surgeons. Subsequent right ventricle dilation, right ventricular dysfunction and fatal arrhythmias as chronic PR complications have important impact on the postoperative quality of life and long-term survival. Current treatment choice for PR includes pulmonary valve replacement（PVR）, intervention, and hybrid procedures. PVR is the main surgical method for chronic PR which can significantly improve patient cardiac function and clinical symptoms，and prolong long-term survival. Intervention does not require thoracotomy once again, and can thus reduce surgical trauma and risks. Intervention is also helpful to improve right ventricular pressure conditions and PR degree. This article focuses on the pathophysiological changes of chronic PR after surgical repair of TOF, surgical indications for PVR, clinical treatment progress and early prevention of PR.