Presbitero P, Demarie D, Aruta E, Villani M, Disumma M, Ottino G M, Orzan F, Fubini A, Spinnler M T, Conte M R
Istituto di Medicina e Chirurgia Cardiovascolare, Università di Torino, Italy.
Ann Thorac Surg. 1988 Sep;46(3):297-301. doi: 10.1016/s0003-4975(10)65928-0.
Today, total correction of tetralogy of Fallot is rarely performed in adults. In a 10-year period, 40 patients aged 20 to 67 years underwent intracardiac repair in our institution. Twenty-eight of them had had a palliative procedure 11 to 30 years earlier. Preoperatively, 23 patients were in New York Heart Association (NYHA) Functional Class II, 14 were in Class III, and 3 were in Class IV. Operative mortality was 2.5% (1/40). Follow-up ranged from 1 year to 11 years (average, 3 years). One patient died of a noncardiac cause 4 years after operation. Residual cardiac defects were observed in 4 patients. Postoperatively, 30 patients were in NYHA Functional Class I, 8 were in Class II, and 1 was in Class III. Major ventricular arrhythmias were recorded in 7 (35%) of 20 patients. Radionuclide angiography demonstrated impaired right ventricular function in 8 patients. Left ventricular impairment was present in 2. Total correction of tetralogy of Fallot can be performed safely in adults with low mortality and good functional improvement. The incidence of residual cardiac defects is low. The long-term importance of impaired ventricular function and arrhythmias remains to be ascertained.
如今，法洛四联症的完全矫正术在成人中很少实施。在10年期间，40例年龄在20至67岁的患者在我们机构接受了心内修复术。其中28例在11至30年前曾接受过姑息性手术。术前，23例患者处于纽约心脏协会（NYHA）心功能II级，14例处于III级，3例处于IV级。手术死亡率为2.5%（1/40）。随访时间为1年至11年（平均3年）。1例患者术后4年死于非心脏原因。4例患者观察到残留心脏缺陷。术后，30例患者处于NYHA心功能I级，8例处于II级，1例处于III级。20例患者中有7例（35%）记录到主要室性心律失常。放射性核素血管造影显示8例患者右心室功能受损。2例存在左心室功能受损。法洛四联症的完全矫正术可在成人中安全实施，死亡率低且功能改善良好。残留心脏缺陷的发生率较低。心室功能受损和心律失常的长期影响仍有待确定。
