Airan Balram, Choudhary Shiv Kumar, Kumar Honnakere Venkataiya Jayanth, Talwar Sachin, Dhareshwar Jayesh, Juneja Rajnish, Kothari Shyam Sunder, Saxena Anita, Venugopal Panangipalli
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Ann Thorac Surg. 2006 Oct;82(4):1316-21; discussion 1321. doi: 10.1016/j.athoracsur.2006.03.115.
The aim of this study was to analyze the feasibility and early results of transatrial total correction of tetralogy of Fallot (TOF).
Of the 860 patients undergoing total correction for TOF between January 2000 and July 2005, 334 patients were considered morphologically suitable for transatrial total correction. The ventricular septal defect (VSD) closure, infundibular resection, and pulmonary valvotomy were performed through the right atrium without a right ventriculotomy. Age ranged from 6 months to 40 years (median, 2.8 years), and weight ranged from 5.5 to 70 kg (median, 14 kg).
Peroperatively, 34 patients required right ventriculotomy and transannular patch; hence, they were excluded from the study. In addition, pulmonary arteriotomy was required in 71 patients (22.9%). There were 4 hospital deaths. There were 4 early reoperations (residual/additional VSD in 3 and tricuspid regurgitation in 1). Two patients had complete heart block requiring permanent pacemaker. Echocardiography at discharge showed a peak right ventricular outflow tract gradient of 20 +/- 5.2 mm Hg. Mean follow-up was 26.8 +/- 4.2 months (range, 1 to 52 months). The right ventricular outflow tract gradients reduced to 13 +/- 4.2 mm Hg after a mean interval of 18.8 +/- 5.2 months. Follow-up New York Heart Association class was I in 240 cases (82%), II in 49 (16%), and III in 7 (2%). There were no late deaths or reoperations.
Transatrial total correction of TOF can be accomplished in selected patients with good early results. In 300 cases (90%), the feasibility of transatrial total correction could be predicted accurately.
本研究旨在分析经心房法对法洛四联症（TOF）进行根治术的可行性及早期结果。
在2000年1月至2005年7月期间接受TOF根治术的860例患者中，334例在形态学上适合经心房法根治术。通过右心房进行室间隔缺损（VSD）修补、漏斗部切除及肺动脉瓣切开术，无需进行右心室切开术。年龄范围为6个月至40岁（中位数为2.8岁），体重范围为5.5至70千克（中位数为14千克）。
术中，34例患者需要进行右心室切开术及跨环补片修补，因此被排除在本研究之外。此外，71例患者（22.9%）需要进行肺动脉切开术。有4例患者在医院死亡。有4例早期再次手术（3例为残余/额外VSD，1例为三尖瓣反流）。2例患者出现完全性心脏传导阻滞，需要植入永久性起搏器。出院时超声心动图显示右心室流出道峰值压差为20±5.2毫米汞柱。平均随访时间为26.8±4.2个月（范围为1至52个月）。平均间隔18.8±5.2个月后，右心室流出道压差降至13±4.2毫米汞柱。随访时纽约心脏协会心功能分级为I级的有240例（82%），II级的有49例（16%），III级的有7例（2%）。无晚期死亡或再次手术病例。
经心房法对TOF进行根治术在部分患者中可以完成，且早期结果良好。在300例患者（90%）中，可以准确预测经心房法根治术的可行性。
