Rittenhouse E A, Mansfield P B, Hall D G, Herndon S P, Jones T K, Kawabori I, Stevenson J G, French J W, Stamm S J
J Thorac Cardiovasc Surg. 1985 May;89(5):772-9.
One hundred twenty-four patients with tetralogy of Fallot have undergone either primary total repair (61), shunt and later repair (30), or an initial shunt (33). The mean ratio of pulmonary anulus to descending thoracic aorta increased from 0.80 +/- 0.25 before the shunt to 1.22 +/- 0.26 before the repair (p less than 0.0001). The mean ratio in the primary repair group was 1.23 +/- 0.25. A transannular patch was necessary in only six of 91 patients (6.6%). Postrepair right ventricular/left ventricular pressure ratio averaged 0.50 +/- 0.11 in the shunt plus repair group and 0.43 +/- 0.12 in the primary repair group. Only four patients had a right ventricular/left ventricular pressure ratio less than 0.65. A significant inverse linear relationship existed between this ratio and the pulmonary anulus size measured at operation and normalized for the patient's height (p less than 0.01). Postoperative complications occurred in 21% of patients after a shunt and 20% of patients after open heart repair. The early mortality was 0.8% (1/124). An initial shunt in patients with a small pulmonary anulus can result in an increased anulus size and better hemodynamic result with frequent avoidance of a transannular patch. Staged repair may result in improved overall mortality rates.
124例法洛四联症患者接受了一期完全修复（61例）、分流及二期修复（30例）或初次分流（33例）。肺环与降主动脉的平均比值从分流前的0.80±0.25增加到修复前的1.22±0.26（p<0.0001）。一期修复组的平均比值为1.23±0.25。91例患者中仅6例（6.6%）需要跨环补片。分流加修复组修复后右心室/左心室压力比平均为0.50±0.11，一期修复组为0.43±0.12。仅4例患者的右心室/左心室压力比小于0.65。该比值与手术时测量的并根据患者身高进行标准化的肺环大小之间存在显著的负线性关系（p<0.01）。分流术后21%的患者和心脏直视修复术后20%的患者出现术后并发症。早期死亡率为0.8%（1/124）。对于肺环小的患者，初次分流可导致肺环增大，血流动力学结果改善，且常可避免使用跨环补片。分期修复可能会提高总体死亡率。
