Pallative procedures combined with intervention techniques for tetralogy of Fallot with severe hypoplastic pulmonary artery / 中华胸心血管外科杂志

ABSTRACT

Objective To evaluate the results of palliative procedures combined with intervention techniques for tetralogy of Fallot with severe hypoplastic pulmonary artery.Methods From December 2002 to Decembre 2009,complete repair of tetralogy of Fallot were performed in 1586 patients including 18 cases ( 12 male and 6 female) with severe hypoplastic pulmonary artery after 8 - 40 (20 + 11 ) month of palliative operations.The patients'age and body weight were 12 - 72 months and 8.0 - 16.5 kg at the time of complete repair.Associated cardiac anomalies include 3 cases of atrial septal defect,2 cases of absence of left pulmonary artery,1 case of the left pulmonary artery arising from the aorta,1 case of left superior vena cava.Major aortopulmonary collateral arteries were confirmed by angiography in 7 patients.Palliative operation was performed once in 13cases,twice in 4 cases and thrird in 1 patient before complete repair.Palliative operations included 14 procedures of Blalock-Taussig shunt,6 of Waterston shunt,3 of right ventricle outflow tract reconstruction and 3 of balloon pulmonary valvuloplasty.Major aortopulmonary collateral arteries were ligated in 4 cases,unifocalized in 1 and interventional embolized in 2 before complete repair.Results There was no early death.One reoperation was performed because of the obstruction of vascular prosthesis in the next day of shunt operation.Nakata index [ (84 ±40) versus (200 ±81 )] and McGoon ratio were increased after complete repair as compared with before operation [ ( 1.14 + 0.33 ) versus ( 1.77 + 0.51 ),P ＜ 0.001 ].Hemoglobin decreased from ( 175 ±46) g/L to ( 149 ± 15 ) g/L (P ＜0.05) and peripheral oxygen saturation increased from (71 ±9)％ to ( 86 ± 5 ) ％ ( P ＜ 0.05 ).Complete repair were performed in all 18 patients eventually.Conclusion Palliative procedures combined with intervention techniques may ameliorate the growth of pulmonary artery effectively and improve the results of complete repair of tetralogy of Fallot with severe hypoplastic pulmonarv arterv.