The Analysis Of Tetralogy Of Fallot With Aortic Insufficiency

Objective: generalize the tetralogy of Fallot with aortic insufficiency clinicalexperience.Method: Collected2cardiac surgery patients with tetralogy of Fallot and aorticinsufficiency from January2012to November2012First Hospital Affiliated to DalianMedical University.Cases1,8-year-old female child, echocardiography: aortic saddle(50%), pulmonary valve stenosis, ventricular septal defect, right ventricular hypertrophy,patent ductus arteriosus, aortic valve calcification and nearly moderate regurgitation.Left ventricular ejection fraction (LVEF) was45%. Case2,46-year-old male patient, noobvious symptoms of cyanosis, previous diagnosis of infective endocarditis. Left sternalborder Ⅲ～Ⅳ the intercostal smelt rough continuous murmur. Echocardiography:ventricular septal defect, on ventricular level blood flow from left ventricular to rightone, right coronary valve in aortic valve prolapse with moderate regurgitation,pulmonary valve narrow and the visible excrescence on the edge of them, rightventricular hypertrophy, left ventricular ejection fraction (LVEF)57%. Two patientswere under cardiopulmonary bypass with general anesthesia. About10%aortastraddling on the interventricular septum were found during operation. Finally twopatients underwent aortic valve replacement and radical operation of tetralogy of Fallot.Case1underwent ductus arteriosus ligation. After operation strengthen the use ofantibiotics to prevent infection. By analyzing clinical data of the two patients such assurgical indications, surgical options, postoperative treatment and treatment ofcomplications to explore treatment experience rare cases about the tetralogy of Fallotand aortic insufficiency.Result: Case1, ICU stranded in5d.4days after operation, the body temperature risedto38.6℃. Vancomycin were used to resist infection, dose in750mg/d, the temperature got normal and relatively stable. Case2,ICU stranded1d and3hours after operationblood pressure is very unstable, fluctuating between55-65mmHg and35-45mmHg,large doses of vasoactive drugs blood pressure rose to100/70mmHg, and remainedrelatively stable. Two patients with postoperative echocardiography: the value ofpulmonary artery diameter and right ventricular outflow tract increased compared withpreoperative. Left ventricular ejection fraction had no significant changes comparedwith preoperative; compared with the preoperative oxygen pressure in blood increased.Six months follow-up review after operation, two patients can be carried out the dailyphysical activities, situations improved. Echocardiography in patients artificial aorticvalve was working properly, neither exploration of regurgitation, ventricular level norresidual shunt, left and right ventricular function perform well.Conclusion:1. Tetralogy of Fallot with aortic valve regurgitation in patients take operation aorticvalve replacement and radical surgery of tetralogy of Fallot as early as possible, notonly to improve hypoxia and alleviate the cyanosis, but also can avoid furtherdeterioration of left ventricular function.2. The early period after operation hemodynamic is unstable while strengthenpostoperative management and avoid ICU cross-infection are of great importance.