法洛四联症的晚期外科治疗
Late surgical treatment of tetralogy of Fallot.
作者信息
Tchoumi J C T, Ambassa J C, Giamberti A, Cirri S, Frogiola A, Butera G
机构信息
St Elizabeth Catholic General Hospital, Cardiac Centre, Shisong, Cameroon.
出版信息
Cardiovasc J Afr. 2011 Jul-Aug;22(4):179-81. doi: 10.5830/CVJA-2010-057.
AIM
To study early post-operative results and follow up of patients over a year old, operated on for tetralogy of Fallot (ToF).
METHODS
This retrospective analysis included 22 patients (14 male and eight female) with a mean age of 9.18 ± 6.5 years (range 13.5 months to 26 years), who underwent complete repair of ToF between April 2003 and June 2009. Data from patients' records, pre-operative cardiac catheterisation studies, operative intervention, and pre-operative and postoperative two-dimensional echocardiographic studies were reviewed. All patients underwent complete repair including closure of ventricular septal defect (VSD). A trans-annular patch was used in 12 patients while an infundibular patch was used in 10 others. Patients were evaluated one, three, six and 12 months after surgery, and annually thereafter. The duration of follow up was from eight months to six years post surgery.
RESULTS
Classical ToF was found in 10 patients. Twelve cases had associated anomalies: two patients with hypoplastic pulmonary artery branches, two with arterial duct malformations, and eight had proximal stenosis of the left branch of the pulmonary artery. NHYA class distribution was as follows: class I: two patients; class II: five subjects; class III: 10 patients; class IV: five subjects. The mean stay in hospital was 15 ± 7 days. Two patients (9%) died during the early post-surgical period. At a mean follow-up interval of 32 ± 9 months, all patients were asymptomatic and in NYHA class I. No late deaths occurred. In three patients, we registered isolated monomorphic ventricular extrasystoles. The right ventricle outflow tract (RVOT) pressure gradient was 29 ± 1.5 mmHg in the acute post-surgical period and it did not change significantly during follow up. The right ventricular function was defined as normal in 95% of the patients in the study and was mildly depressed in 5%.
CONCLUSION
Even if treated later in life, our study showed very good surgical results of patients with ToF.
目的
研究一岁以上法洛四联症（ToF）患者术后早期结果及一年以上的随访情况。
方法
本回顾性分析纳入了22例患者（14例男性，8例女性），平均年龄为9.18±6.5岁（范围为13.5个月至26岁），这些患者于2003年4月至2009年6月期间接受了ToF的完全修复手术。回顾了患者病历、术前心导管检查研究、手术干预以及术前和术后二维超声心动图研究的数据。所有患者均接受了包括室间隔缺损（VSD）闭合在内的完全修复。12例患者使用了跨环补片，另外10例患者使用了漏斗部补片。术后1个月、3个月、6个月和12个月对患者进行评估，此后每年评估一次。随访时间为术后8个月至6年。
结果
10例患者为典型ToF。12例伴有相关异常：2例肺动脉分支发育不良，2例动脉导管畸形，8例肺动脉左支近端狭窄。纽约心脏协会（NHYA）分级分布如下：I级：2例患者；II级：5例患者；III级：10例患者；IV级：5例患者。平均住院时间为15±7天。2例患者（9%）在术后早期死亡。在平均随访间隔32±9个月时，所有患者均无症状，处于NYHA I级。无晚期死亡病例。3例患者记录到孤立性单形性室性期前收缩。术后急性期右心室流出道（RVOT）压力梯度为29±1.5 mmHg，随访期间无明显变化。研究中95%的患者右心室功能正常，5%的患者右心室功能轻度降低。
结论
即使在生命后期进行治疗，我们的研究显示ToF患者的手术效果非常好。
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