Evaluate The Surgical Effect Of Tetralogy Of Fallot By Transthoracic Echocardiography

Objectives1. To approach the whole surgical effect and changing tendency of tetralogy of Fallot (TOF), by transthoracic echocardiography (TTE).2. To approach the surgical effect of TOF of different surgical way by TTE.3. To approach the surgical effect of TOF of different surgical age by TTE.MethodsFollowing up 260 patients who have finished primary repair of TOF at department of cardiac surgery shandong provincial hospital from Aug 1993 to Dec 2006, advising them to recheck by letter. 85 patients have come back and been examined by TTE, and 10 age-matched normal persons have finished the TTE examination too. First, there are 29 patients having finished 3 TTE examination after surgery: about 10 days after surgery, about 4 months after surgery and this returning examination. Comparision has been done during their 4 TTE results (before and after surgery). Second, According to different surgical repair of right ventricular out tract (RVOT) and pulmonary artery (PA), 85 patients have been devided into 4 groups: only RVOT infundibular repair, RVOT infundibular repair and the discission of pulmonary valve (PV), RVOT enlarged repair with transannular patch (TAP), RVOT enlarged repair with TAP and reconstruction of pulmonary valve (PV). Comparision has been done during the TTE results of the 4 groups and the normal control. Eventually, two groups who had more patients (RVOT infundibular repair and the discussion of PV, RVOT enlarged repair with TAP) have been chosen and devided into 5 groups respectively, according to different surgical age: <1y,1～4y, 4～10y, 10～18y, > 18y, then comparision has been done during the 5 groups. Results1. The whole surgical effect and changing tendency of TOFThe obstruction of RVOT obviously eased shortly (our data is 10 days or so after repair) after surgery, while the change of left ventricle (LV) and right ventricular anterior wall (RVAW) is late (our data is 4 months or so after repair). Although the residual gradient pressure of RVOT and the RVAW are better as time longer, but they can not become normal in our research time. PA is obviously larger shortly after surgery, while its change is slow as time longer. Aorta (AO) does not diminished obviously but tends to expand after surgery.2. The surgical effect of TOF of different surgical way Comparision of results before surgery: the group's division bydifferent surgical way, actually is the personification of different serious degree of RVOT or PA, which reflects the different status of the disease. The patients who finished the RVOT enlarged repair with TAP (including reconstruction of PV) are most serious before surgery, their AO expands obviously and their PA is the worst growth. The patients who only repaired the RVOT infundibular is relatively best before surgery, their afterload of RV is smallest in spite of the narrowest RVOT.Comparision of results after surgery: The surgical effect of patients who have only repaired the RVOT infundibular is best. Besides their myocardial pathological changes can not be totally removed in our research time, other parameters are normal. RV and the heart's proportion of Patients who have PV stenosis can not become normal after surgery. RVOT repair with TAP can make RVOT and PA widen, then make LV dilate, and can make the RVOT smoother, but it makes pulmonary regurgitation (PR) worse, which is the risk factor of RV dilation but no relation with RV diastolic hypofunction. TAP can accelerate the happen of RV diastolic hypofunction, while TAP with the reconstruction of PV can make PR obviously less ,then to normal. The LV dysplasia of TOF is not irreversible. If the surgery is successful, the pulmonary circulation volume and LV volume can increase, and LV function can become normal. Because the patients have myocardial fatty dystrophy, it is difficult for the obstruction of RVOT to totally eliminate.3. The surgical effect of TOF of different surgical age. Comparision of results before surgery: In the condition that every group of different surgical age has the similar extent of TOF's abnormality, comparison hints that the PA dysplasia can become significantly worse in the TOF patients without surgical repair from 4y. Comparision of results after surgery: Repair of TOF in infancy is of great benefit to the recovery of myocardial fatty dystrophy, which makes the myocardium recover faster when the hemodynamics in normal. Repair of TOF in adulthood makes the recovery of LV function not ideal, meanwhile Adult myocardial compliance and tolerance is lower, which can caused higher RV pressure and PR easily, so follow-up should be reinforced. After surgery in the same surgical way that includes the muscle bundle resection and PV discussion, the residual gradient pressure of RVOT is obviously larger in the patients whose surgical age is above 4y, considering it is relevant to the pathological changes of PA. The smaller surgical age is, the better recovery of PA is. Patients of different surgical age have similar PA volume corresponding to themselves after surgery. Right ventricular diastolic dysfunction after surgery has no relevance to surgical age, and PR caused by discussion of PV only has no relevance to surgical age too. PR doesn't correlate with the higher right ventricular pressure. The changes of heart cnambers after surgery which have no relevance to the surgical age are caused by the change of blood volume which happen following the change of hemadynamics. Conclusions1.The heart parameters improve obviously after primary repair of TOF. and can be more better as time longer ,but it is difficult for them to be normal.2. The surgical effect of TOF of different surgical way has relevance to the degree of RVOT's abnormality or PA's growth, the better PA's growth is, the better surgical effect is. To advise that the reconstruction of PV be done when repairing RVOT with TAP, which can improve the surgical effect.3. Repair of TOF in infancy makes the recovery of heart better, while repair in adulthood may cause the worse LV function, higher right ventricular pressure and PR.4. PR is the risk factor of right ventricular dilation, but no relation with RV diastolic hypofunction (the influence of surgery not except).