Right Ventricular Outflow Tract Reconstruction In Patients With Tetralogy Of Fallot-an Analysis Of 40 Cases

Tetralogy of Fallot (TOF) is one of the most common, cyanosed, complex, congenital heart disease.The present Comprehension of medical scientist about TOF include some cardinal content as followd: Pulmonary stenosis, ventricular septal defect, aorta bestride and right ventricular hypertrophy. Pulmonary stenosis involve right ventricular outflow tract, pulmonary valve ring, pulmonic main trunk and the two pulmonary branches stenosis or obstruction. The cases which do not meet the above conditions can not be called as TOF. Cyanosed, squatting and clubbed finger (toe) arethe common clinical situation.With the development in reaserch in TOF, the therapy methods are getting more and more. Total correction of TOF has had a history of almost 50 years, and becomes flawless increasingly, whose effect is satisfactory, The objective of total correction is to close VSD, relieve the obstruction of RVOT, and broaden narrow pulmonary artery. At present, the improvement of operation methods mainly focus on ways of dredging RVOT-ways of RVOT reconstruction. The key of total correction of TOF is to relieve the obstruction of RVOT successfully and not to result in pulmonary regurgitation. In recent years, we performed modified operation with pericardial monocusp for right ventricular outflow tract reconstruction, and have got some clinical experience. Theclinical data of 40 patients who were performed on with total correction of TOF in the first affiliated hospital of Zhengzhou university from 2001.1-2004.1 were analyzed to study the recent effect of RVOT reconstruction with modified pericardial monocusp, and it will be helpful to cure the disease of TOF in the future. Materials and MethodsFrom Jan.2001 to Jan.2004, 40 patients who have TOF with pulmonary artery hypoplasia received surgical total correction with RVOT reconstruction were randomly divided into research group (n=20) and control group(n=20). The patients in the research group used the modified technique of transannular patch with a autologous pericardial monocuspid valve, routine technique of a transannular patch with pericardial monocuspid valve was used in control group. ECG, X-ray, echocardiography were taken before operation and 1 week, 6 months after operation. To compare the degree of pulmonary regurgitation and heart function change after operation between the two groups, All data was reported as mean + SD, Statistical analysis was performed using Independent-Samples T Test, results were considered statistically significant if p value was less than 0.05. ResultsNo surgical mortality was recorded after operation. 3 cases in control group occurred pleural effusion in contrast to 1 case in research group . 1 case occurred pneunomia after operation. The preoperative echocardiograms and the patients' characteristics were similar at operation ( Table 1 ), and there are notstatistically signification between the two groups in time of using respirator, doses of dopamine and intensive care unit and hospital lengths of stay(Table 2).But the results indicated that the area of pulmonary valve regurgitation in research group had significantly decrease in contrast to those in control group (F<0.05)(Table 3 and 4 ). Therefore, total correction of TOF with modified pericardial monocusp in RVOT reconstruction has effect on decreasing pulmonary valve regurgitation. ConclusionPulmonary valve function is the key to prevent postsurgical pulmonary regurgitation and right ventricular dilataltion for patients with TOF who have received RVOT reconstruction operation. Lot's of materials and methods have been used in RVOT reconstruction, and had both virtue and flaw. The ideal material should be autologous tissue charactered with having growth potency, powerful anti-infection,long-term lasting, easy availability. We used the modified technique of transannular patch with a autologuous pericardial monocuspid valve which can effectively prevent pulmonary regurgitation and stenosis, have got satisfactory therapeutic efficacy and won an advantage over routine technique of transannular patch patch with pericardial monocusp . Although the possibility exist that the function of pericardial patch with monocuspid valve would retrogress in the future, it still is a kind of ideal material used in repair operation. Additionally, because of short follow-up time, long-term therapeutic efficacy need our further observation.