Surgical treatment of tetralogy of fallot in 142 infants: 5-year follow-up data / 第二军医大学学报

ABSTRACT

Objective To summarize the clinical experiences of surgical treatment of tetralogy of Fallot (TOF) in infants, and to evaluate its short- and midterm efficacy. Methods The clinical data of 142 infants with TOF preoperatively diagnosed by cardiac color Doppler ultrasound and or cardiac CT angiography were retrospectively reviewed. There were 79 males and 63 females with a mean age of (6.4 ± 2.7) months (range 112 months) and a mean body weight of (6.7±1.4) kg (range 3.0-12.0 kg). The mean McGoon index was 1.59 ± 0.34 (range 0.80-2.47) and the left ventricular end diastolic volume index was 25.5 ± 5.9 (range 14.0-36.3). One-stage radical operation was performed in 138 cases under moderate hypothermic cardiopulmonary bypass, and staging radical operation was performed in 4 cases. Results The mean time of cardiopulmonary bypass, arrest of the ascending aorta, post-operative ventilation, and 1CU stay were (95.0 ± 21.7) min, (54.3 ± 15.1) min, (40.2 ± 30.5) h. and (5.0 ± 3.5) d. respectively. Two cases died in the early postoperative period, with the mortality being 1. 4%. Reoperation in the early postoperative period was performed in 4 cases (2.8%). The incidence rate of postoperative complications was 7.0% (10/142). including low cardiac output syndrome, pulmonary infection, acute renal failure and so on. Medium term clinical follow-up was achieved in 127 (89.4%) cases. The mean follow-up time ranged from 11 to 62 months (median 37 months). There was no death or reoperation during the follow-up period. The cardiac function NYHA class I was found in 117 cases, and class II in 10 cases. During the follow-up period, all patients had normal right ventricular ejection fraction, and various degrees of pulmonary regurgitation (PR). including trace or mild PR in 113 cases (89.0%) and moderate PR in 14 cases (11.0/m). Conclusion Radical operation of TOF in infants is safe and effective, with satisfactory short- and medium-term outcomes. Optimizing operation method and strengthening the perioperative management are the keys to improve the successful rate of operation in TOF infants, with satisfactory early- and mid-term curative effect.