Dharmapuram Anil Kumar, Ramadoss Nagarajan, Goutami Vejendla, Verma Sudeep, Pande Shantanu, Devalaraja Sindhura
Paediatric Cardiac Surgery, Division of Paediatric Cardiac Sciences, Krishna Institute of Medical Sciences (KIMS Hospitals), Secunderabad, Telangana, India.
Paediatric Cardiac Anaethesiology, Division of Paediatric Cardiac Sciences, Krishna Institute of Medical Sciences (KIMS Hospitals), Secunderabad, Telangana, India.
Ann Pediatr Cardiol. 2021 Jul-Sep;14(3):315-322. doi: 10.4103/apc.APC_166_20. Epub 2021 Aug 11.
During repair of tetralogy of fallot (TOF) we modified surgical strategies to preserve the valve and annulus if the pulmonary valve leaflets are pliable and not significantly dysplastic.
Initially, the repair was done from the main pulmonary artery (Group-1, 215 patients) and later through an additional incision in the infundibulum of the right ventricle (Group-2, 73 patients). Recently, we changed the approach to commissurotomy of the fused leaflets by releasing the supra valvar tethering and delamination of the cuspal apparatus till the base to improve the mobility of the cusps and do a controlled commissurotomy (Group-3, 14 patients). With delamination, we could extend the limit of the repair to a z-score of -3.5.
There was no hospital mortality; two patients died at home after discharge. A mean follow-up of 42.01 months ± 19.25 is available for 198 patients (92%) for group 1, 16.03 ± 7.45 for group 2, and 4.07 ± 2.09 for group 3. The re-intervention-free survival is 94.4% in group 1. The z value improved from -3 (-3--2) to -1.2 (-3 - 0), = 0.001 in Group 1, from -2.8 (-3--2.4) to -1 (-1.1--0.7), = 0.001 in Group 2 and from -3 (-4--3) to -1, = 0.001 in Group 3. In all the groups, there was trivial or mild pulmonary regurgitation.
During repair of TOF, adequate valve/annulus sparing is possible if the repair is done from both the main pulmonary artery and infundibular incisions using the delamination technique.
在法洛四联症（TOF）修复术中，如果肺动脉瓣叶柔软且发育不良不明显，我们会修改手术策略以保留瓣膜和瓣环。
最初，修复从主肺动脉进行（第1组，215例患者），后来通过在右心室漏斗部增加一个切口进行（第2组，73例患者）。最近，我们改变了融合瓣叶的连合切开方法，通过松解瓣上束缚并将瓣尖装置分层至基部，以改善瓣尖的活动度并进行可控的连合切开（第3组，14例患者）。通过分层，我们可以将修复的限度扩展至z值为 -3.5。
无院内死亡；两名患者出院后在家中死亡。第1组198例患者（92%）的平均随访时间为42.01个月±19.25，第2组为16.03±7.45，第3组为4.07±2.09。第1组无再次干预生存率为94.4%。第1组的z值从 -3（-3至-2）改善至 -1.2（-3至0），P = 0.001；第2组从 -2.8（-3至-2.4）改善至 -1（-1.1至-0.7），P = 0.001；第3组从 -3（-4至-3）改善至 -1，P = 0.001。在所有组中，均有轻微或轻度肺动脉反流。
在TOF修复术中，如果使用分层技术从主肺动脉和漏斗部切口进行修复，则有可能充分保留瓣膜/瓣环。
