Surgical Treatment Of Tetralogy Of Fallot In Infancy

Objective 1,To review the experiences of radical correction of Tetralogy of Fallot ( TOF)in infants; 2,investigate the postoperative prognosis associated with timing, mode, approaches, risk factors and to select reasonable surgery therapy.Methods Between Aug. 2003 and May.2008, 83 children underwent radical correction of TOF, one-stage was performed in 75 cases and the palliative operation in 8cases, and two-stage was performed in 3 cases. The mdian age was (20.3±8.5) months and weight was (9.7±2.1) kg. 17 cases have repeatedly hypoxia, part patients'symptom graveness, even unconsciousness and respiratory failure ,including preoperative need 1 ventilator support. Preoperative heart on the basis of clinical manifestation, sternum, electrocardiogram and ultrasonic cardiography, only 1 case of cardiovascular angiography. 75 patients cured, 90% of the first right ventricular septal defect repair, 62 cases received enlargement procedures of right ventricular outflow tract (RVOT) across the pulmonary valve ring, mean bypass time (89.0±19.0) min, the interruption aortic surgical time was (66.0±12.0) min. Palliative operation, systemic-pulmonary arterial shunt(Blalock-Taussig shunt or B-T shunt), was used in 8 cases who doesn't correction of interventricular septal defect only restrictively enlarge right ventricular; ventriculus dexter and lung artery trunk to fit 2/3 standard value, according to their McGoon index and left ventricle development status, two-stage radical operation was done in 3 of them 11 to 15 months later.Results There were 79 operative Survivors , postoperative ventilator support 24.0±31.0 hours, Intensive Care Therapy (2.4±2.5)days, the median postoperative hospital stay was 7.1 days. Continuous cardiac dysfunction and liver damage, the sternum, acute renal failuredoraemon severe complication such as 9 cases were cured, or better handle. 2 died after one-stage radical surgery and the other 2 after palliative procedure, to part with 2.7(2/75)and25(2/8)percent of mortality. Patiens of two-stage radical surgery no death.Follow-up of 3-62 months(median 43±8.1), no long-term death. 78 cases of sinus rhythm, no serious cardiac arrhythmia, 1 atrioventricular separation, the heart can not do well maintained and further processing. Ventricular outflow tract obstruction in 3 patients (train residual VSD), experiment. it residual shunt in 3 patients. Medium tricuspid regurgitation in 5 cases, including 1 cases of severe, open-minded, 1-year proportion of chronic cardiac insufficiency.Conclusion Infant stage can obtain satisfactory results cured issue. Especially when Mcgoon index more than1.28, but left ventricular dysplasia of recent prognosis still have adverse effect, A critical stage to avoid children treatment. Eradicative reseetion of pulmonary artery and tricuspid regurgitation have long-term damage, especially the cross pulmonary valve, ring patch is worthy of further attention.