Walsh E P, Rockenmacher S, Keane J F, Hougen T J, Lock J E, Castaneda A R
Department of Cardiology, Children's Hospital, Boston, MA 02115.
Circulation. 1988 May;77(5):1062-7. doi: 10.1161/01.cir.77.5.1062.
Between 1973 and 1985, 220 infants (age 1 day to 18 months, mean = 7 months) underwent repair of tetralogy of Fallot (TOF) or TOF/pulmonary atresia with 17 early deaths. Follow-up status was ascertained for 184 of 203 survivors (91%) at a postoperative interval of 2 to 185 months (mean = 60 months). Significant residual hemodynamic lesions included ventricular septal defect in three, and right ventricular outflow gradient in excess of 40 mm Hg in 24. Reoperation or interventional catheter procedures were performed in 31 of 184 (17%) patients. All postoperative electrocardiograms were reviewed; only two of 184 patients had ventricular ectopy on any tracing. Holter data from 41 patients revealed one with sinus node dysfunction, 12 with Lown grade 1 ectopy, and one with Lown grade 2 or greater. Conduction defects, evaluated by electrocardiographic and electrophysiologic measurements, were not different from those reported for TOF patients undergoing repair at later ages. No study patient received antiarrhythmic medication, although one required a pacemaker for sinus node dysfunction. There were three late deaths, all unrelated to arrhythmia. TOF repair in infancy appears to be associated with an acceptable hemodynamic outcome, and a low incidence of ventricular ectopy and sudden death at 5 year follow-up.
1973年至1985年间，220例婴儿（年龄1天至18个月，平均7个月）接受了法洛四联症（TOF）或TOF/肺动脉闭锁修复术，其中17例早期死亡。对203例幸存者中的184例（91%）进行了随访，术后随访时间为2至185个月（平均60个月）。显著的残余血流动力学病变包括3例室间隔缺损，24例右心室流出道梯度超过40 mmHg。184例患者中有31例（17%）接受了再次手术或介入导管手术。对所有术后心电图进行了复查；184例患者中只有2例在任何一次心电图检查中有室性早搏。41例患者的动态心电图数据显示，1例有窦房结功能障碍，12例有洛恩1级早搏，1例有洛恩2级或更高等级早搏。通过心电图和电生理测量评估的传导缺陷与年龄较大时接受修复术的TOF患者报告的情况没有差异。没有研究患者接受抗心律失常药物治疗，尽管有1例因窦房结功能障碍需要起搏器。有3例晚期死亡，均与心律失常无关。婴儿期TOF修复术似乎与可接受的血流动力学结果以及5年随访时较低的室性早搏和猝死发生率相关。
