Chittithavorn Voravit, Rergkliang Chareonkiat, Chetpaophan Apirak, Vasinanukorn Prasert, Sopontammarak Somkiat, Promphan Worakan
Division of Cardiovascular Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
J Med Assoc Thai. 2006 Jan;89(1):43-50.
The surgical management of tetralogy of Fallot (TOF) has continued to evolve and there are now generally excellent early and long-term results following complete repair.
To investigate the early results of the authors' current surgical management of TOF by assessing the perioperative and early to intermediate follow-up period. The authors paid particular attention to the post-operative ratio of right ventricular to left ventricular systolic pressure (RVSP/LVSP), focusing on the presence of low cardiac output, intensive care unit (ICU) stay, prolonged of inotropic support and ventilation support time.
Retrospective study.
Between June 2002 and August 2004, 31 consecutive patients underwent complete repair of TOF. Their mean age was 7.7 +/- 5.1 years (range, 2.9 to 25.3). A previous palliative shunt had been performed in 14 (45.2%) patients. Twenty-three patients (74.2%) were in NYHA FC II. Mean hematocrit and oxygen saturation were 50.9 +/- 10.25% and 80.5 +/- 8.6%, respectively. Mean preoperative ratio of RVSP/LVSP was 1.1 +/- 0.15. The operative approach was transatrial/transpulmonary, and 17 (54.8%) patients required a transannular patch. An extracardiac valve conduit was necessary in 3 (9.7%) patients with pulmonary atresia.
There were no operative or late deaths. Two cases were reoperated from cardiac tamponade. Mean postoperative ratio of RVSP/LVSP was 0.53 +/- 0.16. Median ICU and hospital stays were 2.2 and 11 days, respectively. Presence of low cardiac output and prolonged inotropic support were significantly (P < 0.05) related to a RVSP/LVSP ratio of more than 0.5. At median follow-up of 6 months, 29 (93.5%) patients were asymptomatic and all patients were free of significant residual lesion.
The authors' early results in complete repair of TOF patients are acceptable with a low incidence of morbidity. A postoperative RVSP/LVSP ratio of more than 0.5 was significantly associated to adverse outcome. Late complications may, however, develop, and long term follow-up for early detection of any such complications is essential.
法洛四联症（TOF）的外科治疗一直在不断发展，目前完全修复后的早期和长期效果总体良好。
通过评估围手术期以及早期至中期随访期，研究作者目前对TOF的外科治疗的早期效果。作者特别关注右心室与左心室收缩压术后比值（RVSP/LVSP），重点关注低心输出量、重症监护病房（ICU）停留时间、延长的强心支持和通气支持时间的情况。
回顾性研究。
2002年6月至2004年8月期间，31例连续患者接受了TOF的完全修复。他们的平均年龄为7.7±5.1岁（范围为2.9至25.3岁）。14例（45.2%）患者曾接受过姑息性分流术。23例（74.2%）患者为纽约心脏协会（NYHA）心功能分级II级。平均血细胞比容和血氧饱和度分别为50.9±10.25%和80.5±8.6%。术前RVSP/LVSP的平均比值为1.1±0.15。手术入路为经心房/经肺动脉，17例（54.8%）患者需要跨环补片。3例（9.7%）肺动脉闭锁患者需要心外瓣膜管道。
无手术死亡或晚期死亡。2例因心包填塞再次手术。术后RVSP/LVSP的平均比值为0.53±0.16。ICU停留时间和住院时间的中位数分别为2.2天和11天。低心输出量的存在和延长的强心支持与RVSP/LVSP比值大于0.5显著相关（P<0.05）。在6个月的中位随访期，29例（93.5%）患者无症状，所有患者均无明显残余病变。
作者对TOF患者进行完全修复的早期效果可以接受，发病率较低。术后RVSP/LVSP比值大于0.5与不良结局显著相关。然而，可能会出现晚期并发症，因此进行长期随访以早期发现任何此类并发症至关重要。
