Park Chun Soo, Kim Woong-Han, Kim Gi-Beom, Bae Eun Jung, Kim Jin-Tae, Lee Jeong Ryul, Kim Yong Jin
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea.
J Card Surg. 2010 Jul;25(4):394-9. doi: 10.1111/j.1540-8191.2010.01053.x. Epub 2010 May 30.
Debate continues over the optimal timing for total repair of tetralogy of Fallot. Here, we report our experience with early one-stage total repair of tetralogy of Fallot.
Between January 2000 and March 2008, surgical treatment was required in 24 symptomatic patients who were diagnosed with tetralogy of Fallot at less than three months of age. Among them, total repair was performed in 13 patients (group 1) and initial palliation was done in the others (group 2). The median follow-up duration was 20 months (5 to 40 months) and 67 months (1 to 100 months) in each group.
There was one operative death in group 2. The duration of mechanical ventilatory support, and the lengths of intensive care unit stay and hospital stay were not statistically different between both groups. The ventricular septal defects were repaired through the right atrium in 12 patients (12/13, 92.3%) of group 1 and nine patients (9/11, 81.8%) of group 2 (p = 0.576). Transannular repair was performed in six patients (6/13, 46.2%) of group 1 and 10 patients (10/11, 90.9%) of group 2 (p = 0.036). Reintervention or reoperation was required in two patients of group 1 and three of group 2 (p = 0.630). During follow-up, the pulmonary arterial growth was more prominent in group 1.
Early one-stage total repair of tetralogy of Fallot can be performed safely without increasing the risk for reoperation or reintervention, in the short term. The pulmonary annulus is likely to be preserved when it is repaired at an early age. Early total repair may be better for the pulmonary arterial growth than staged repair.
法洛四联症完全修复的最佳时机仍存在争议。在此，我们报告我们早期一期法洛四联症完全修复的经验。
2000年1月至2008年3月期间，24例年龄小于3个月且被诊断为法洛四联症的有症状患者需要接受手术治疗。其中，13例患者进行了完全修复（第1组），其余患者进行了初始姑息治疗（第2组）。每组的中位随访时间分别为20个月（5至40个月）和67个月（1至100个月）。
第2组有1例手术死亡。两组之间机械通气支持时间、重症监护病房住院时间和住院时间在统计学上无差异。第1组12例患者（12/13，92.3%）和第2组9例患者（9/11，81.8%）通过右心房修复室间隔缺损（p = 0.576）。第1组6例患者（6/13，46.2%）和第2组10例患者（10/11，90.9%）进行了跨环修复（p = 0.036）。第1组2例患者和第2组3例患者需要再次干预或再次手术（p = 0.630）。随访期间，第1组肺动脉生长更为显著。
短期内，早期一期法洛四联症完全修复可以安全进行，而不会增加再次手术或再次干预的风险。早期修复时肺动脉瓣环可能得以保留。早期完全修复可能比分期修复更有利于肺动脉生长。
