Fuster V, McGoon D C, Kennedy M A, Ritter D G, Kirklin J W
Am J Cardiol. 1980 Oct;46(4):635-42. doi: 10.1016/0002-9149(80)90514-7.
Four hundred seventy-five patients underwent repair of tetralogy of Fallot from 1955 to 1964; 396 of these were hospital survivors and were followed up for 12 to 22 years. An excellent late clinical result was maintained by 87 percent of the 396 hospital survivors. A less than excellent result in the remaining 13 percent of hospital survivors was caused by late mortality in 7 percent (sudden death in 3 percent, death due to cardiac causes in 2 percnt and death due to noncardiac causes in 2 percent), required reoperation in 4 percent (mainly because of residual ventricular septal defect) and development of symptoms in 2 percent. Postoperative cardiomegaly (cardiothoracic ratio greater than 0.55) was observed in 60 (25 percent) of 246 patients who had a follow-up chest roentgenogram, and was more common among those who died late or remained symptomatic. Among the few patients with inadequate surgical relief of right ventricular hypertension who did not have transanular patch repair, the hypertension did not tend to decrease progressively, whereas it did decrease in patients who had patch repair. No late sudden deaths were encountered in 20 patients shown to have postoperative right bundle branch block plus left axis deviation (bifascicular block pattern). Pulmonary valve incompetence appeared to have relatively little harmful influence on the late result, causng cardiac disability in 1 percent of the patients and appeared to be the main contributing factor of postoperative cardiomegaly in 13 (5 percent) of the 246 patients who had a follow-up chest roentgenogram. Most late deaths and complicatins appeared within 2 years of operation, and accelerating deterioration in late results did not occur as the follow-up extended beyond 2 decades.
1955年至1964年间，475例患者接受了法洛四联症修复手术；其中396例为住院幸存者，随访时间为12至22年。396例住院幸存者中，87%维持了良好的晚期临床效果。其余13%的住院幸存者效果欠佳，原因包括7%的晚期死亡（3%为猝死，2%为心脏原因死亡，2%为非心脏原因死亡），4%需要再次手术（主要是因为残余室间隔缺损），2%出现症状。在246例接受随访胸部X线检查的患者中，60例（25%）观察到术后心脏增大（心胸比率大于0.55），在晚期死亡或仍有症状的患者中更为常见。在少数未进行跨环补片修复、右心室高压手术缓解不充分的患者中，高血压并未逐渐减轻，而进行补片修复的患者中高血压有所减轻。在20例术后出现右束支传导阻滞加左轴偏移（双分支阻滞模式）的患者中，未发生晚期猝死。肺动脉瓣关闭不全对晚期结果的有害影响相对较小，1%的患者出现心脏功能障碍，在246例接受随访胸部X线检查的患者中，13例（5%）的肺动脉瓣关闭不全似乎是术后心脏增大的主要促成因素。大多数晚期死亡和并发症出现在术后2年内，随着随访时间延长超过20年，晚期结果并未加速恶化。
