Lillehei C W, Varco R L, Cohen M, Warden H E, Gott V L, DeWall R A, Patton C, Moller J H
Ann Surg. 1986 Oct;204(4):490-502. doi: 10.1097/00000658-198610000-00017.
Tetralogy of Fallot became a correctable malformation on August 31, 1954, and from that data through 1960, 106 patients (ages 4 months-45 years) who underwent open repairs at the University of Minnesota and were discharged, have been followed (99% complete) until death or for 26-31 years (mean: 23.7 years, 2424 patient years). The purposes of this study were to determine survival, morbidity, hemodynamics, educational/employment attainments, and relation of these to surgical technics. Operations were done by cross circulation (6 patients) and bubble oxygenator (100 patients). This group had the first uses of patch ventricular septal defect closure, outflow root, infundibuloplasty, atresia correction, ischemic arrests, and pacemakers among other innovations. Twenty-one (of 105 patients) have died during the followup: eight deaths in the first 10 years, 12 between 10 and 20 years, and 1 greater than 20 years. The causes of death were sudden (5), accidental (4), congestive failure (2), reoperation (2), suicide (2), and other (2). Actuarial survival at 30 years was 77%. Late complications were ten reoperations, five arrhythmias, and one endocarditis. Actuarial freedom from reoperations at 30 years was 91%. Cardiac recatheterizations in 62 patients disclosed only 10 with residual shunts. Peak right ventricular systolic pressures were less than 40 mmHg (34 patients), 41-60 mm (2 patients), 61-70 mm (4 patients), greater than 71 mm (4 patients). Thirty-four patients (32%) completed college, ten of these completed graduate school (5 masters degrees, 2 M.D.'s, 2 Ph.D.'s, 1 lawyer). Fifteen others attended college, and nine received technical school diplomas. Forty patients (18 men, 22 women) had progeny, with 82 (93%) live births and six major cardiac defects (7.3%). In summary, complete repair gave excellent late results in this group cared for very early in the open heart era. Survivors led productive lives without restrictions in education and employment. Many of the deaths/complications that occurred are now easily preventable, which augurs extremely well for this generation.
1954年8月31日，法洛四联症成为一种可矫正的畸形病症。自那时起至1960年，明尼苏达大学对106例患者（年龄4个月至45岁）进行了体外循环心内直视修复手术并使其出院，随后对这些患者进行了随访（随访率99%），直至患者死亡或长达26至31年（平均23.7年，总计2424患者年）。本研究的目的是确定患者的生存率、发病率、血液动力学、教育/就业成就，以及这些因素与手术技术的关系。手术采用交叉循环（6例患者）和鼓泡式氧合器（100例患者）进行。该组患者首次采用了补片修补室间隔缺损、流出道根部修复、漏斗部成形术、闭锁矫正术、缺血性停搏和起搏器等创新技术。在随访期间，105例患者中有21例死亡：前10年中有8例死亡，10至20年之间有12例死亡，20年以上有1例死亡。死亡原因包括猝死（5例）、意外（4例）、充血性心力衰竭（2例）、再次手术（2例）、自杀（2例）和其他原因（2例）。30年的精算生存率为77%。晚期并发症包括10例再次手术、5例心律失常和1例心内膜炎。30年无再次手术的精算自由度为91%。对62例患者进行心脏导管检查发现，只有10例存在残余分流。右心室收缩压峰值小于40 mmHg（34例患者）、41 - 60 mmHg（2例患者）、61 - 70 mmHg（4例患者）、大于71 mmHg（4例患者）。34例患者（32%）完成了大学学业，其中10例完成了研究生学业（5个硕士学位、2个医学博士学位、2个博士学位、1个律师学位）。另外15例上过大学，9例获得了技术学校文凭。40例患者（18名男性，22名女性）有后代，共82例活产，其中6例患有严重心脏缺陷（7.3%）。总之，在心脏直视手术时代早期接受治疗的这组患者中，完全修复取得了出色的晚期效果。幸存者能够过上不受教育和就业限制的充实生活。现在，许多发生的死亡/并发症很容易预防，这对这一代人来说是个非常好的兆头。
