Das Asit, Lakhani Gaurav, Kar Debdatta, Mishra Lopamudra, Mollah Nur Nabab, Tewary Shubham
Department of Cardiology, IPGMER and SSKM Hospital, Flat B1, GB 43, Narayantala West, D. B. Nagar, Kolkata, 700059, India.
J Cardiothorac Surg. 2024 Dec 19;19(1):651. doi: 10.1186/s13019-024-03172-1.
Tetralogy of Fallot (TOF) is the most common congenital cyanotic heart disease and is characterized by an antero-superior deviation of the infundibular septum with a consequent large malaligned ventricular septal defect (VSD) and a pulmonary and sub-pulmonary (infundibular) stenosis. Surgical repair has been the cornerstone of treatment that is electively performed early in their lives between 3 and 6 months of age. With advancements in transcatheter interventions, the complete percutaneous repair of TOF, a complex disease with multiple treatable lesions, is becoming a conceivable possibility. Here, we report the case of total transcatheter correction of an 18-year-old boy with TOF, performed in two stages. The first stage involved addressing the right ventricular outflow tract (RVOT) obstruction with balloon pulmonary valvuloplasty (BPV) and occluding the conal artery using absolute alcohol and a coil. In the second stage, the VSD was closed with a Multifunctional Occluder (MFO) Konar device 14 -12 mm (Lifetech, China). While surgical treatment remains the gold standard for total correction of TOF, the transcatheter approach can also be considered for selected group of patients who are surgically turned-down.
法洛四联症（TOF）是最常见的先天性青紫型心脏病，其特征为漏斗间隔前上移位，继而导致大型对位不良的室间隔缺损（VSD）以及肺动脉和肺下（漏斗部）狭窄。手术修复一直是治疗的基石，通常在患儿3至6个月大时择期进行。随着经导管介入技术的进步，对于TOF这种具有多种可治疗病变的复杂疾病，完全经皮修复正逐渐成为一种可能。在此，我们报告一例18岁TOF男孩经导管完全矫正的病例，分两个阶段进行。第一阶段采用球囊肺动脉瓣成形术（BPV）解决右心室流出道（RVOT）梗阻，并使用无水乙醇和弹簧圈封堵圆锥动脉。第二阶段，使用14 - 12毫米的多功能封堵器（MFO）Konar装置（中国深圳微创医疗器械有限公司）关闭室间隔缺损。虽然手术治疗仍是TOF完全矫正的金标准，但对于部分手术拒绝的患者，也可考虑经导管治疗方法。
