Edmunds L H, Saxena N C, Friedman S, Rashkind W J, Dodd P F
Surgery. 1976 Dec;80(6):681-8.
In 12 months since March, 1975, 25 of 27 patients with tetralogy of Fallot have had corrective operations without ventriculotomy. Infundibular obstructions were excised and ventricular septal defects were closed through a right artiotomy with retraction of the anterior leaflet of the tricuspid valve. Pulmonary valve stenosis was relieved through a pulmonary arteriotomy. In five patients the pulmonary annulus was patched 0.5 to 1.5 cm. into the right ventricle. Immediately after repair peak right ventricular-pulmonary arterial systolic pressure difference averaged 17 mm. Hg and ranged between zero and 40 mm. Hg. Cardiac indices averaged 2.85 L. per square meter per minute 4 hours after operation. All but two patients developed right bundle branch block. One patient with severe pulmonary hypertension died. Fourteen patients have been recatheterized. Right ventricular-pulmonary peak systolic pressure differences ranged between zero and 45 mm. Hg (mean, 22). Cineangiograms show contraction of the free right ventricular wall during systole. Transatrial repair of tetralogy of Fallot is feasible technically in many patients, avoids muscle necrosis and coronary arterial injury, and improves cardiac output in the immediate postoperative period.
自1975年3月起的12个月内，27例法洛四联症患者中有25例接受了不做心室切开术的矫正手术。切除漏斗部梗阻，通过右心房切开术并牵拉三尖瓣前叶来闭合室间隔缺损。通过肺动脉切开术缓解肺动脉瓣狭窄。5例患者的肺动脉瓣环向右心室补片0.5至1.5厘米。修复后立即测得的右心室-肺动脉收缩压峰值压差平均为17毫米汞柱，范围在0至40毫米汞柱之间。术后4小时心脏指数平均为每分钟每平方米2.85升。除2例患者外，所有患者均出现右束支传导阻滞。1例重度肺动脉高压患者死亡。14例患者接受了再次心导管检查。右心室-肺动脉收缩压峰值压差范围在0至45毫米汞柱之间（平均22毫米汞柱）。电影血管造影显示右心室游离壁在收缩期收缩。法洛四联症经心房修复术在许多患者中技术上是可行的，可避免肌肉坏死和冠状动脉损伤，并在术后即刻改善心输出量。
