Department of Surgery, Division of Cardio-Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Ann Thorac Surg. 2010 Mar;89(3):858-63. doi: 10.1016/j.athoracsur.2009.12.060.
The management of neonates with symptomatic tetralogy of Fallot (TOF) requiring surgical intervention in the first month of life remains controversial. We reviewed our experience with neonates 30 days or greater with TOF from 2002 to 2008 requiring surgical intervention.
Thirty-seven consecutive symptomatic nonrandomized neonates with TOF or its variants (including TOF with complete atrioventricular septal defect or absent pulmonary valve but excluding pulmonary atresia) had either a shunt (n = 17) or primary repair (n = 20). The shunted patients more commonly required emergency operation (24% vs 0%; p = 0.036); otherwise, the two groups were similar.
One infant with preoperative bowel ischemia died one day postoperatively after emergency shunting. There were two late deaths 11 and 12 months postoperatively, both in primary repair patients. The 16 surviving shunted patients had TOF repair 216 +/- 99 days after the original shunt. The shunted patients had shorter intensive care unit and hospital stays for the first operation, which became equivalent when the second hospitalization (repair) values were added. The primary repair patients more frequently had a transannular patch and a tendency to more frequent delayed sternal closure. Four primary repair (20%) and two shunted (12.5%) patients required subsequent cardiac operations after complete repair (p = not significant).
Shunting or primary repair of neonates with symptomatic TOF provides equivalent mortality and results. Shunted patients had fewer transannular patch repairs despite having more emergent initial operations. Compared with the primary repair group, shunted patients had decreased intensive care unit and hospital stays for the first hospitalization, which were neutralized when the second operation (repair) values were added.
对于需要在出生后第一个月内接受手术干预的有症状四联症（TOF）新生儿的管理仍存在争议。我们回顾了 2002 年至 2008 年期间需要手术干预的 30 天或以上的有症状非随机 TOF 新生儿或其变体（包括 TOF 伴完全房室间隔缺损或无肺动脉瓣但不包括肺动脉闭锁）的经验。
37 例连续的有症状非随机 TOF 或其变体（包括 TOF 伴完全房室间隔缺损或无肺动脉瓣但不包括肺动脉闭锁）新生儿患者接受了分流术（n = 17）或直接修复术（n = 20）。分流组患者更常需要急诊手术（24%比 0%；p = 0.036）；否则，两组患者相似。
1 例术前肠缺血的婴儿在急诊分流术后一天死亡。2 例患者于术后 11 个月和 12 个月死亡，均为直接修复患者。16 例存活的分流患者在最初分流后 216 ± 99 天进行 TOF 修复。分流患者的重症监护病房和首次手术住院时间较短，当第二次住院（修复）值加入时，这两种情况变得相等。直接修复患者更常使用跨环补片，且有延迟胸骨闭合的趋势。4 例直接修复（20%）和 2 例分流（12.5%）患者在完全修复后需要进一步心脏手术（p = 无统计学意义）。
分流或直接修复有症状的 TOF 新生儿可获得等效的死亡率和结果。尽管分流患者的初始紧急手术较多，但接受了较少的跨环补片修复。与直接修复组相比，分流患者的首次住院重症监护病房和住院时间较短，当加入第二次手术（修复）值时，这两种情况变得相等。
