The Study On Improving The Effects Of Primary Repairing For Young Children With Tetralogy Of Fallot

Objective: Debate on the proper timing of repair of tetralogy of Fallot (TOF) is still continuing. We used several methods to improve the effect of primary repare of classified TOF. We analyzed early clinical results of repair of TOF to investigate potential risk factors and evaluate the effects of the methods we used. Methods:From March 2005 to June 2006, consecutive 60 young children with symptomatic TOF (without pulmonary atresia) were operated. Ages ranged from 0.6 to 3 - year-old (1.85±0.78), 34 patients were 1 to 2 year-old, 2 patients wre 7,8 month, respectively, 24 patients older than 2 - year-old. Mean weight was 11.13±2.20kg, from 6.0 to 14kg. 24 patients weighted≤10kg, 36 patients weighted＞10kg. 56 patients received transannular patches. VSD in 42 patients were repaired through right atrial incision. To investigate the death ratio, complications, duration of respiratory machine using, ICU staying, inotropics drug using, and hospital staying after operation. Analying the data with SAS software, the consecutive variants with t-test, the number variants with x~2 test, P＜0.05 is signifciant differrence, P＜0.01 is extremly signifciant differrence.Results:1. The hospital mortality rate was 1.7% and there were no late deaths. Follow-up time was 1 - 23 months. One died from acute respiratory difficult syndrome. Neither the age or weight or McGoon rate＜1.5 or Nakata index＜150mm~2/m~2 had signifciant deference affecting the death rate. 2. The LVEDd (P＜0. 001), LVEDs (P＜0. 01), the diameter of MPA (P＜0. 05) of the＞2-year-old children greater than that of the≤2-year-old children. 3. Only the right ventricular diameter had signifciant diference between≤10k g and＞10k gchildren, 4. There is no signifciant diference of the time of aortic clamping, age and weight between ICU staying≤7 days and＞7 days. 5. There is no signifciant diference of the time of respiratory machine using, ICU staying, postive muscle drug using, and hospital staying after operation between the children VSD repaired through right atrial or right ventricular incision, and so on the diferent myocardial cardioplegia liquid. 6. The patients less than 2-year-old,less than 10kg,McGoon rate less than 1. 5,Nakataindex less than 150mm~2/m~2, has sound opearation results, but the time of respiratory machine using, ICU staying, inotropics drug using, longer than the others, has extrem signifciant diference, P＜0. 001. Conclusion: 1. With deep understangding of the pathological change of TOF in infants and young children and modification of, surgical skill, 1-2 years old patients can have excellent results of correction of TOF ,despite of the weight less than 10kg and Nakata index less than 150mm~2/m~2, McGoon rate less than 1. 5 without cardiovascular angiography. 2. The VSD can be repaired through right atrial incision, with decreasing the time of aortic clamping, but without increasing the time of inotropics drug using and ICU staying. 3. The protein heart protection liquid has good effect like the blood protection liquid to the young patients.