| Objective : To sum up the clinical experience from 56 cases of radical correction of tetralogy of Fallot .Methods : Retrospectively analyzing the clinic data, surgical treatment and efficacy of the 56 cases of radical correction of tetralogy of Fallot in our hospital from January, 2002 to August ,2006.Clinic data : The analyzed object involved 56 patients, including 29 male and 27 female with the ages ranging from 2 to 36 years,(mean 10.6±7.8y),and the weight 10 to 67 kg,(mean 26.8±15.6kg). The clinical manifestations were cyanosis to different extents,limitation to the action, squatting history and clubbing of fingers(toes). Five cases had apopsychia history by anoxic blue spell. The electrocardiogram(ECG) showed right ventricular hypertrophy in the whole group and complete right bundle branch block in 14 cases. The radiotelegram of chest indicated decreasing pulmonary blood vessels and the majority of patients showed Coeur en sabot with cardiothoracic ratio of 42%-66% (mean 56.5±5.1%).Preoperative transcutaneous oxygen saturation ranged from 65% to 89% (mean 78.4±6.1%), the hematocrit (HCT) 0.28~0.82 (mean 0.45±0.14) and the hemoglobin 126-235g/l (mean 168.5±32.4) g/l. All patients were diagnosed by echocardiogram (ECHO) showing the rate of overriding aorta ranged from 30%-55% (mean 42.1±8.0%) and diameter of ventricular septal defect(VSD) 0.6-2.5cm (mean1.8±0.4)cm. There were 52 infra-cristal and 4 infra-truncus VSD in the whole group and all of the patients shared stenosis of right ventricular outflow tract(RVOT) and pulmonary stenosis(PS) in different degrees. Two suspected peripheral pulmonary artery stenosis(PPAS) patients took the right heart catheterization getting the consistent result with ECHO, and McGoon ratio of them were 1.2,1.4. During the operation we found simply infundibular stenosis or associated pulmonary stenosis in 16 cases ,and mixed stenosis in 40 cases . The associated malformations included atrial septal defect(ASD) 21 cases, patent ductus arteriosus(PDA) 3cases,and both ASD and PDA 2cases.Surgical techniques:All the cases underwent corrective surgery in the condition of general anaesthesia and cardopulmonary bypass(CPB) with hypothermia (nasopharyngeal temperature of 25-30°C) and priming volume ranging from 60-100 ml/ kg.min.During the operation temperature and flow were adjusted according to the situation. Adopt the longitudinal incision of RVOT, and then separate and excise hypertrophy parietal band and septal band, and open the stenosis pulmonary valve or ring according to the details. Widen RVOT or(and) pulmonary artery adopting autologous pericardial patch with 16 cases only broadening pulmonary artery, 40 cases across pulmonary ring of which 15 cases patched to the left and right pulmonary artery bifurcation.The widening standard was according to the weight of the patients, and then took the corresponding probe to test.Continuously sutured with 4-0prolene line to repair VSD,and then added 2-3 interrupted mattress suture at tricuspid valve at the juncture of the septal and former cusp of atrioventricular valve to reinforce. For the patients who associated PDA the arterial canal was freed and deligated before CPB and after aortic clamping. ASD or acleistocardia was repaired after the correction of VSD and RVOT.Results : The mean aortic clamping time was (56.7±18.0 min) and the mean CPB time was (83.2±26.4 min).During the past two years, some of our patients used ultrafiltration with the quantity of 200-800ml. The surgical mortality was 3.6% (2/56). And the causes of death were serious low cardiac output and perfusion lung. The common postoperative complications were low cardiac output(1 case excluding the above-mentioned 1), perfusion lung(2 cases excluding the above-mentioned 1),reoperation by sternal infection(1 case), pleural effussion(2 cases)all of which were cured , while 3 cases of residual shunt of VSD which is less than 3mm in diameter were untreated. The mean Postoperative staying course was 11 days followed by the follow-up survey for 3 months to 2 years during which period we concluded the heart function(NYHA) of class I or II with the good growth, increased resistance for activities and normal learning and living ability. Applying the paired t-test to compare the parameter of preoperation with the postoperative after one week, P<0.05 this test was statistically significant.Conclusion: 1,Total relief of obstruction of right ventricular outflow tract and reasonable broadening of pulmonary artery as well as strict repairing of ventricular septal defect are the key factors of successful operation. 2,Widening right ventricular outflow tract and pulmonary artery with autologous pericardial patch can effectively resolve pulmonary stenosis and obstruction of right ventricular outflow tract in addition to remnant obstruction. 3,Postoperative pulmonary complications occurred mostly among the infants,so that using deep hypothermic low flow (DHLF) bypass technique during intraoperation can effectively protect lung function and reduce the occurrence of postoperative complications. 4,Consummate guardianship in ICU and timely postoperative treatment are imprortant measures to decrease the mortality .
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