RESUMO
Background @#The frequency of tetralogy of Fallot among newborns and infants is 5.6-14.0% of all congenital heart defects [5, 14, 17] The most frequent complication of the early postoperative period is right ventricular failure, which is formed when the anatomy of the right ventricle and the progressive pulmonary regurgitation are disturbed [1, 3, 12]. With the development of new minimally invasive methods of examination and their introduction into clinical practice, the understanding of hemodynamic parameters after surgical correction, pathophysiological mechanisms of development of right ventricular dysfunction has improved. </br> One of these methods is transpulmonary thermodilution and pulse waveform analysis, which allows in the early hours after operation to determine preload, heart function and postload parameters [9, 20]. </br> In the long-term period, many patients after radical correction have right ventricular dysfunction due to many years of massive pulmonary regurgitation. With the introduction of MRI improved understanding of the pathophysiological mechanisms of development of right ventricular dysfunction.. Recent reports indicate that the global functional assessment of the right ventricle after surgical correction does not reflect its present function [7, 10].@*Aim@#The aim of the study was to estimate the early postoperative indices of hemodynamics in different types of the right ventricular output plastics after radical correction of Fallot’s tetralogy and to access the functional state of the right ventricle in the long- term postoperative period.@*Materials and Methods@#On the basis of cardiovascular surgery department of the Shastin P.N. hospital, a prospective cohort study of 52 patients (28 boys, 24 girls), underwent radical correction of Fallot’s tetralogy, was conducted. </br> Patients were divided into 2 groups by the type of reconstruction of the right ventricular outlow tructs: group I included patients with transannular plasty of the output part (group I, 26 patients), group II-patients with preserved fibrous ring of the pulmonary artery (group II, 26 patients). The postoperative hemodynamic status was assessed with transpulmonary thermodilution. The right ventricular function in the long-term period was estimated by means of US and MRI.@*Results@#During the first postoperative hours, hemodynamic indices according transpulmonary thermodilution technique were significantly lower in group I and reliable differed from group II. However, later (12.24,48 hour after), restoration of hemodynamic indices in group I, which did not significantly differ from group II, was observed. In the long-term period, ejection of the right ventricle was reliable higher in group II, while terminal diastolic volume of the right ventricle was significantly higher in group I. Pulmonary regurgitation was also significantly higher in group I-36.7 (32,44) versus 13,2 (3;14) (p<0,01).@*Conclusions@#Preservation of pulmonary artery fibrous ring provides better parameters of hemodynamics in the early postoperative period including systolic and diastolic functions. In the long-term period, this group of patients is less subjected to the right ventricular function.
RESUMO
@#The study of indices of heart remodeling was performed in children with secondary atrial septal defects (ASDs) after either endovascular or surgical repair of the defects. The data analysis showed that serious ASDs lead to diastolic left ventricular (LV) dysfunction. Recovery of LV function occurred during the first day following endovascular repair or after six months following surgical correction. Maximum reduction of dilatation of the right heart chambers after ASD repair is recorded in the early postoperative period and keeps during follow up, regardless of the method for the defect repair. We found a significant depression in mechanical activity of left atrium after surgical repair with the recovery one year after the procedure.