Talwar Sachin, Anand Abhishek, Siddarth Bharat, Ramakrishnan Sivasubramanian, Choudhary Shiv Kumar, Airan Balram
Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India.
Ann Pediatr Cardiol. 2019 Jan-Apr;12(1):3-9. doi: 10.4103/apc.APC_40_18.
We compared the pre- and post-operative right ventricular (RV) function by tricuspid annular plane systolic excursion (TAPSE) between trans-right atrial (t-RA) versus t-RA/RV (RA/RV) approach for the repair of Tetralogy of Fallot (TOF).
Fifty consecutive patients, 1-15 years of age, undergoing intracardiac repair of TOF between September 2015 and June 2016 were randomized into two groups based on the approach for repair as follows: t-RA or t-RA/RV approach. TAPSE was used for the assessment of pre- and post-operative RV function.
Age, body surface area, preoperative saturation, cardiopulmonary bypass and aortic cross-clamp times, inotropic score, postoperative intensive care unit, and hospital stay were similar in both the groups. However, t-RA/RV group had significant mediastinal drainage (169 ± 163 ml vs. 90.6 ± 58.7 ml, < 0.05) and pleural effusions (8 vs. 2 patients, < 0.05), but had better relief of RV outflow tract gradients. The mean follow-up was 23 ± 6.7 (median 26, range 21-29) months. There were no differences in arrhythmias in either group up to the 1 month and at last follow-up. Preoperative TAPSE for t-RA and t-RA/RV was similar (1.49 ± 0.29 vs. 1.66 ± 0.34, > 0.05) and so was the post-operative TAPSE at discharge (1.52 ± 0.30 vs. 1.43 ± 0.32, > 0.05), at 1 month (1.6 ± 0.27 vs. 1.43 ± 0.032, > 0.05) and at last follow-up (1.79 ± 0.15, median 1.8 vs. 1.72 ± 0.17, median 1.7 > 0.05).
Both t-RA and t-RA/RV approaches provide safe palliation for patients with TOF. A limited right ventriculotomy neither leads to deleterious effects on early RV function nor does it increase the incidence of arrhythmias at early follow-up. Larger studies with longer follow-up are needed to further address these issues.
我们比较了经右心房（t-RA）与经右心房/右心室（RA/RV）入路修复法洛四联症（TOF）时，术前和术后右心室（RV）功能的三尖瓣环平面收缩期位移（TAPSE）情况。
2015年9月至2016年6月期间，50例年龄在1至15岁之间接受TOF心内修复的连续患者，根据修复入路随机分为两组：t-RA组或t-RA/RV组。TAPSE用于评估术前和术后RV功能。
两组患者的年龄、体表面积、术前饱和度、体外循环和主动脉阻断时间、血管活性药物评分、术后重症监护病房及住院时间均相似。然而，t-RA/RV组纵隔引流量显著更多（169±163ml对90.6±58.7ml，P<0.05），胸腔积液患者更多（8例对2例，P<0.05），但RV流出道梯度缓解更好。平均随访时间为23±6.7（中位数26，范围21 - 29）个月。两组在术后1个月及最后随访时心律失常发生率均无差异。t-RA组和t-RA/RV组术前TAPSE相似（1.49±0.29对1.66±0.34，P>0.05），出院时术后TAPSE也相似（1.52±0.30对1.43±0.32，P>0.05），1个月时（1.6±0.27对1.43±0.32，P>0.05）以及最后随访时（1.79±0.15，中位数1.8对1.72±0.17，中位数1.7，P>0.05）。
t-RA和t-RA/RV入路对TOF患者均提供了安全的姑息治疗。有限的右心室切开术既不会对早期RV功能产生有害影响，也不会增加早期随访时心律失常的发生率。需要进行更大规模、更长随访时间的研究来进一步解决这些问题。
