Vogt J, Wesselhoeft H, Luig H, Schmitz L, De Vivie E R, Weber H, Beuren A J
Thorac Cardiovasc Surg. 1984 Aug;32(4):234-43. doi: 10.1055/s-2007-1023393.
The preoperative and postoperative findings in 627 patients operated for correction of tetralogy of Fallot (TOF) in the period 1960 to 1984 were analyzed in order to evaluate the clinical and hemodynamic late results. The average age was 7.2 years (range 9 months to 30 years). The patients were divided into 4 groups in order to determine the long-term prognosis in relation to the severity of the underlying anatomy; group I = without outflow tract patch; group II = with a patch up to the valve base; group III = with a transannular patch (TAP); group IV = TAP or valved conduit in patients with pulmonary atresia. Preceding shunt operations had been performed in 350 patients (55.8%); a primary correction was carried out in 277 cases (44.1%). Hospital mortality for all patients operated from 1960 to 1984 was 14.0%, late mortality, by contrast, was only 1.1%. In the last 4 years (1980 to 1983), the overall mortality considerably decreased to 3.4% (n = 29) for patients without TAP and to 8.0% for all operated patients including those with pulmonary atresia (n = 50). A comparison of the actuarial survival curves, moreover, demonstrates that the prognostic survival rate is unequivocally dependent on the severity of the anatomy of a TOF. The hemodynamic results obtained from 271 recatheterized patients from all 4 groups were designated excellent in 106 patients (39.1%), good in 100 (39.9%) and poor in 65 (23.9%). Proximal residual gradients across the right ventricular outflow tract (RVOT) were found in 30.2% of the corrected patients, and distal gradients in 24.3%. Fifty-two patients out of the 627 (8.2%) had to be reoperated for residual VSD, RVOT aneurysm, valvular pulmonary stenosis or peripheral stenosis. Intracardial electrophysiological tests carried out in 166 patients postoperatively showed an antegrade effective refractory period of the AV-node lasting over 400 ms in 47 patients (28.3%), as well as additional ventricular action potentials in 117 patients (70.4%), which could be correlated to extrasystoles or ventricular tachycardia in 37.9% of the cases. Additional AV-pathways were disclosed in 3 patients.(ABSTRACT TRUNCATED AT 400 WORDS)
分析了1960年至1984年期间627例接受法洛四联症（TOF）矫治手术患者的术前和术后情况，以评估临床和血流动力学的远期结果。平均年龄为7.2岁（范围9个月至30岁）。为确定与潜在解剖结构严重程度相关的长期预后，将患者分为4组；I组 = 无流出道补片；II组 = 有补片至瓣膜基部；III组 = 有跨环补片（TAP）；IV组 = 肺动脉闭锁患者采用TAP或带瓣管道。350例患者（55.8%）曾进行过先行分流手术；277例（44.1%）进行了一期矫治。1960年至1984年期间所有手术患者的医院死亡率为14.0%，相比之下，远期死亡率仅为1.1%。在最后4年（1980年至1983年），无TAP患者的总体死亡率大幅降至3.4%（n = 29），包括肺动脉闭锁患者在内的所有手术患者的总体死亡率降至8.0%（n = 50）。此外，精算生存曲线的比较表明，预后生存率明确取决于TOF解剖结构的严重程度。从所有4组的271例再次导管检查患者获得的血流动力学结果显示，106例患者（39.1%）为优秀，100例（39.9%）为良好，65例（23.9%）为差。在矫正患者中，30.2%发现右心室流出道（RVOT）近端残余压差，24.3%发现远端压差。627例患者中有52例（8.2%）因残余室间隔缺损、RVOT动脉瘤、瓣膜性肺动脉狭窄或外周狭窄而需再次手术。166例患者术后进行的心内电生理检查显示，47例患者（28.3%）房室结前传有效不应期超过400毫秒，117例患者（70.4%）有额外的室性动作电位，其中37.9%的病例可与早搏或室性心动过速相关。3例患者发现有额外的房室旁路。（摘要截取自400字）
