| Objective To compare the results of radical repair of Tetralogy of Fallot (TOF) in different age and weight groups, determine the best timing and strategy of surgery and improve the therapeutic effects of low-bodyweight young children with TOF.Methods Between May 2004 and December 2010,239 TOF cases underwent primary repair in single group of our center. According to the age group:group I includes 58 cases younger than 6 months,37 boys and 21 girls, with the mean age of (4.28±1.31) months and mean weight of (6.28±1.45) Kg; group II includes 92 cases,52 boys and 40 girls, ranging from 6 months to 12 months, with the mean age of (0.17±1.99) months and mean weight of (8.45±1.61)Kg; group III includes 72 cases,42 boys and 30 girls, ranging from 12 months and 24 months, with the mean age of (19.03±3.59) months and mean weight of (10.21±1.47) Kg; groupⅣincludes 17 cases,10 boys and 7 girls, older than 24 months, with the mean age of (39.88±23.49) months and mean weight of (14.00±5.61) Kg.According to the weight: group 1 includes 41 cases, the weight is less than 6 Kg,22 boys and 19 girls, with the mean weight of (5.19±0.60)Kg and mean age of (4.68±2.13) months. Group 2 is 137 cases, ranging from 6kg to 10kg,83 boys and 54 girls, with the mean weight of (8.54±1.11) Kg and mean age of (12.02±5.51) months.group 3 is 51 cases, ranging from 10kg to 15kg,26 boys and 25 girls, with the mean weight of(11.73±1.14) Kg and mean age of (20.73±8.19)months. Group 4 is 10 cases, which are more than 15 Kg,7 boys and 3 girls, with the mean weight of(22.56±8.21) Kg and mean age of (36.57±12.81)months.Preoperative and postoperative major clinical symptoms and follow-up echocardiogram in each group were recorded. The aortic clamping time, cardiopulmonary bypass time, mend a ventricular septal defect repairing route, whether to trans-pulmonary annular patch, the postoperative complications, early death and recently follow-up, were compared. Data was analyzed with SPSS software, the consecutive variants with t-test, the number variants with x2-test, P<0.05 is considered to be of significant difference.Results Five died.The overall mortality was 2.09%. The death in age group:group I was 1 cases, groupⅡwas 2 cases, group III was 2case, and groupⅣwas nobody. The death in Weight group: group 1 of death was 1 case, group 2 had three patients died, while group3 had only one case, but group 4 has no death. No significant difference was recorded in mortality rate (P> 0.05). It was of significant difference in the repairing route, postoperative mechanical-ventilating time, CCU and total in-hospital stay duration (P<0.05) in different age and weight groups. It was of no significant difference in the CPB time, aortic clamp time, the case number of transannular repair (P>0.05). It was of no significant difference(P>0.05) in postoperative complications in each group, includingⅢ°atrioventricular block. After operation, all the cases were followed up from 6 month to 6 years, and the 6-month follow-up rate was 100%. They were arranged for medical examination, electrocardiogram, chest X-ray film and echocardiography. The object of echocardiography was to determine if there was residual VSD shunt and right ventricular outflow obstruction, tricuspid valve and pulmonary valve regurgitation, and so on. No significant difference was observed in the subgroups (P>0.05).Conclusion1. With the improvement in preoperative diagnosis, anesthesia and surgery, postoperative care enhancement, nearly all the TOF children can secure a period with low mortality, except those with unusual outflow coronary artery crossing or multiple VSDs. Weight and age is no longer a major factor restricting radical surgery.2. Small left ventricular and poorly developed pulmonary are no longer the main contraindications. In most cases, echocardiography can make a definite diagnosis, and the majority of TOF do not have to experience right heart catheterization and angiography.3. Pathway through the tricuspid valve can facilitate VSD exposure. The smaller the incision in right ventricular outflow tract, the better。Slight retraction of RV is required. Familiar with the pathological anatomy of TOF, proper repair of ventricular septal defect, reasonably clearing the right ventricular outflow tract, retaining their own pulmonary valve retention and protection of tricuspid valves, will improve long-term survival.5. Strengthen protection of perioperative cardiopulmonary function and postoperative intensive care can improve the convalescence of the young and low bodyweight infants.6. Survival, complication rate and follow-up results of cardiac function in young and low-bodyweight TOF patients are similar with those in older ones. Early surgery can earlier establish normal pulmonary blood flow, improve the oxygen situation, and promote normal development of multy organs. |
PDF Full Text Request