| Objectives:To summarize the clinical experience of surgical treatment of Tetralogy of Fallot.Methods:22 cases of tetralogy of Fallot had underwent surgical operation from March 2008 to January 2010 .There were 12 males and 10 females aging from 9 months to 29 years old, mean age (4.67±6.83) years, and weighted from 7 kg to 49kg, average weight (12.78±10.31) kg. Apart from several exceptions without clubbing, all the other patients had both cyanosis at rest and clubbing. Electrocardiogram showed right ventricular hypertrophy. Chest X-ray film showed Boot-shaped heart, and the cardiothoracic ratio is from 0.44 to 0.63. Pulmonary blood flow reduced in all the cases.Peripheral oxygen saturation was 64.6 ~ 97.6%, with an average peripheral oxygen saturation (83.09±10.60)%, and hemoglobin is 89~205 g / L, average hemoglobin (146.00±38.91) g / L. All the cases had received radical correction of Tetralogy of Fallot under hypothermic cardiopulmonary bypass , Widening the right ventricular outflow tract on 8 cases(36.37%), and right ventricular outflow tract to the pulmonary valve ring widening on 14 cases (63.63%).Results: Postoperative complications occurred in 4 cases (18.18%), including Low cardiac output syndrome 2cases, respiratory failure 1 case, and 1 case(4.55%)died.2 cases suffering Low cardiac output syndrome was cured by intravenous infusion of dopamine, milrinone, dobutamine and so on, making up for blood volume, transfusing whole blood or plasma based on the plasma colloid osmotic pressure, hemoglobin and hematocrit, and enhancing diuresis and other symptomatic treatments.Respiratory failure occured in 1 case, whose condition improved by the control of pulmonary infection, ventilator-assisted breathing and the systemic support therapy. Renal failure occured in 1 case on the first day after surgery, and this patient was given peritoneal dialysis, while two days after surgery , multi-organ failure and low cardiac output appeared, and the partial pressure of oxygen and oxygen saturation declined rapidly, at last his heart beat and breath stopped, he died. Postoperative review of the whole group did not find residual shunt of interventricular septum. Routine postoperative application of dopamine 2.5～10ug/ (Kg·min), average (3.77±2.29) days; milrinone 0.25～0.5ug / (Kg·min), average (2.80±2.91) days; ventilator-assisted time average (1.7±1.1) days. The mean time of stay was (13.17±5.04) days.Conclusion: Tetralogy of Fallot is the most common cyanotic congenital heart disease, surgical treatment is the only option. The main pathophysiological characteristic of Tetralogy of Fallot is hypoxia. So the baby-stage operation is conducive to the protection of right ventricular function, pulmonary artery, especially promotion of the growth and development of Peripheral pulmonary vascular, reducing the damage of chronic hypoxemia to the heart, liver, kidney and nervous system, as well as avoiding or reducing the sudden death caused by preoperative anoxic seizures and late postoperative ventricular arrhythmias. The surgical mortality rate of Tetralogy of Fallot is high, so the surgery should be done in early childhood. The majority can choose one-stage operation, and get satisfactory results. Those whose pulmonary artery developed Poorly should take into account two-stage operation. Early one-stage radical correction can prevent the potential damage of chronic hypoxia to the heart, brain, lung, kidney and other vital organs, and prevent the formation of large secondary systemic-pulmonary collateral . Those with severe distal pulmonary artery hypoplasia could be given palliative surgery to alleviate the hypoxia,and then phased operation. In the group there were 3 cases under the age of 1 year, and the youngest is only 9 months, all the 3 cases underwent radical correction. Satisfying surgical correction is the key to successful operation. The most common postoperative complications included low cardiac output syndrome, multiple organ failure, pulmonary perfusion, hemorrhage, arrhythmia and so on. |
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