Arafat Amr A, Elatafy Elatafy E, Elshedoudy Sahar, Zalat Mahmoud, Abdallah Neamet, Elmahrouk Ahmed
Cardiothoracic Surgery Department, Tanta University, Al-Geish Street, Tanta, 31527, Gharbya, Egypt.
Cardiology Department, Tanta University, Tanta, Egypt.
J Cardiothorac Surg. 2018 Jan 22;13(1):14. doi: 10.1186/s13019-018-0702-0.
Right ventricular (RV) volume overload increases morbidity and mortality after tetralogy of Fallot (TOF) repair. Surgical strategies like pulmonary leaflets sparing and tricuspid valve repair at time of primary repair may decrease RV overload. Our objective is to evaluate early and midterm results of pulmonary leaflets sparing with infundibular preservation and tricuspid valve repair in selected TOF patients with moderate pulmonary annular hypoplasia.
From 2011 to 2016; 46 patients with TOF and moderate pulmonary annular hypoplasia had surgical repair with sparing of the pulmonary valve leaflets. Concomitant tricuspid valve repair was performed in 33 patients (71.8%). Mean age was 13.1 ± 4.8 months, 68% were males (n = 31) and mean weight was 9.5 ± 2.3 kg. Preoperative McGoon ratio was 1.9 ± 0.4 and pulmonary valve z-score ranges from - 2 to - 3. Preoperative pressure gradient of RVOT was 80.9 ± 7.7 mmHg and 10.9% had minor coronary anomalies (n = 5).
All repairs were performed through trans-atrial trans-pulmonary approach. 87% had pulmonary valve commissurotomy (n = 40). Mean cardiopulmonary bypass time was 71 ± 6.3 min and ischemic time 42.4 ± 4.9 min. Hospital mortality occurred in 4.3% (n = 2). Mean RVOT pressure gradient decreased significantly postoperatively (28.8 ± 7.2 mmHg, p-value< .001) and at the last follow up (23.6 ± 1.8 mmHg, p-value< .001). Pulmonary regurgitation progressed by one grade in 2 patients compared to the postoperative grade. 1 patient (2.5%) had late mortality and reintervention was required in 5 patients (12.5%).
Pulmonary leaflets sparing, and tricuspid valve repair are safe for TOF repair with no added morbidity or mortality. These procedures could contribute to reducing right ventricular volume overload over time after TOF repair.
法洛四联症（TOF）修复术后右心室（RV）容量超负荷会增加发病率和死亡率。在初次修复时采用保留肺动脉瓣叶和修复三尖瓣等手术策略可能会减轻RV超负荷。我们的目的是评估在选定的伴有中度肺动脉环发育不全的TOF患者中，保留肺动脉瓣叶并保留漏斗部及修复三尖瓣的早期和中期结果。
2011年至2016年期间，46例伴有中度肺动脉环发育不全的TOF患者接受了保留肺动脉瓣叶的手术修复。33例患者（71.8%）同时进行了三尖瓣修复。平均年龄为13.1±4.8个月，68%为男性（n = 31），平均体重为9.5±2.3 kg。术前McGoon比值为1.9±0.4，肺动脉瓣z值范围为-2至-3。术前RVOT压力梯度为80.9±7.7 mmHg，10.9%（n = 5）有轻微冠状动脉异常。
所有修复均通过经心房经肺动脉途径进行。87%（n = 40）进行了肺动脉瓣交界切开术。平均体外循环时间为71±6.3分钟，缺血时间为42.4±4.9分钟。医院死亡率为4.3%（n = 2）。术后RVOT压力梯度显著降低（28.8±7.2 mmHg，p值<0.001），在最后一次随访时仍显著降低（23.6±1.8 mmHg，p值<0.001）。与术后分级相比，2例患者的肺动脉反流进展了一级。1例患者（2.5%）发生晚期死亡，5例患者（12.5%）需要再次干预。
保留肺动脉瓣叶和修复三尖瓣对TOF修复是安全的，不会增加发病率或死亡率。随着时间的推移，这些手术可能有助于减少TOF修复术后的右心室容量超负荷。
