Mattila S, Luosto R, Ketonen P, Nieminen M, Merikallio E, Kyllönen K E
Scand J Thorac Cardiovasc Surg. 1984;18(1):23-7. doi: 10.3109/14017438409099377.
A series of 42 patients who underwent total correction of tetralogy of Fallot as adults is presented. Previous palliative operation had been performed in 33 cases: Blalock-Taussig shunt in 28 (bilateral in 6), Brock operation in four and Potts' anastomosis in one case. Severe cyanosis (average hemoglobin 203 g/l), thrombotic complications and hypoxic spells were the most pertinent of the clinical manifestations necessitating the total repair. Blalock-Taussig shunt had closed spontaneously before the intracardiac operation in 14 cases (3 bilateral) and in 11 it was ligated. In six cases the shunt was left untreated, being hemodynamically insignificant at operation. Three of the 42 patients died in association with the intracardiac operation. A-V block developed in two patients and required permanent pacemaker. During follow-up periods of up to 13 years, a residual ventricular septal defect was found in seven patients. Two of the defects were surgically closed. Five were not corrected, as the patients were doing well and the pulmonary/systemic flow ratio was less than 1.5 at repeat catheterization. Two-thirds of the patients were in NYHA class I at re-examination, and the others were in class II. The subjective functional improvement was greater than could have been expected from results of exercise tolerance tests.
本文报告了42例成年法洛四联症患者接受根治手术的情况。33例患者曾接受过姑息手术：28例行Blalock-Taussig分流术（6例为双侧分流），4例行Brock手术，1例行Potts吻合术。严重发绀（平均血红蛋白203g/L）、血栓并发症和缺氧发作是需要进行根治手术的最主要临床表现。14例（3例为双侧）患者在心脏内手术前Blalock-Taussig分流已自然闭合，11例进行了结扎。6例患者的分流未予处理，因其在手术时对血流动力学影响不大。42例患者中有3例在心脏内手术时死亡。2例患者发生房室传导阻滞，需要植入永久性起搏器。在长达13年的随访期内，7例患者发现有残余室间隔缺损。其中2例缺损进行了手术闭合。5例未予纠正，因为患者情况良好，再次心导管检查时肺循环/体循环血流比小于1.5。三分之二的患者复查时心功能为纽约心脏协会（NYHA）I级，其余为II级。主观功能改善程度大于运动耐量试验结果预期。
