Surgical issues in tetralogy of Fallot (ToF) treatment

Abstract

Introduction: ToF is a CCD, consisting of subpulmonary infundibular stenosis, ventricular septal defect, aortic valve rightward deviation and right ventricle hypertrophy. It is the most common cyanogens CCD, encountered in more than 50% of. ToF occurs in 5 of 10000 births, in proportion of 54% boys and 46% girls. Many of those who carry ToF, die in the newborn age; those who survive, present essential hemodynamic disorders, with no treatment insights. Survival rates as follows: up tol year- 66%, up to3 years- 40%,up to20 years- 11%, up to40 years- 3%. Patient’s clinical characteristics underlie the surgical behavior, pre- and postoperative evolution of the disease. Aims: Surgical treatment issues remain due to factors, such as optimal age to that lower risk for surgery, the pathologies associated (AP). Material and Methods: Data were collected from patients hospitalized from 2010 to 2011. The sample studied consists of 37 patients (P), 3 months to 32 years aged, including 13 girls and 24 boys. Pre- and postsurgical subjective, objective, paraclinical (electrocardiography, echocardiography, angiocardiography, etc.) data were analyzed from the clinical examination records, by examining the P. The research is based on descriptive, standartization and case-control studies. Depending on the purpose of research, the sample was stratified into predefined categories. Results: During mentioned period, 39 P were hospitalized, 97% planned and 3% emergency, 37 surgeries were made, including 19 palliative shunting, 16radical corrections. Out of all interventions 4 deaths were mentioned (10%). On average, P with ToF present a 3,7 kg (19%) weight and 6,4 cm (7%) height deficiency. Intra- and postoperative complications (IPOC) at P up to 4 years (26 P, 70%) appears as mentioned: 61% without, 30% with 1-2 and 4% with 3 complications; P above 4 years (IIP , 30%): 18% of them have no complications, 63% with 1-2 and 18% present 6-9 complications. Excluding age factor (>4 years), 75% of those without AP (12 P, 46%) have no complications, another 25% - have it, while P with AP (14 P, 54%), majority of them - 71% have IPOC. According to NYHA classification, 62% present 3 -4 levels of heart failure (HF), and another 38% - 1 or 2. Only 4 P (11%) present HF of III or IV level by NYHA postoperative. Conclusions: At P with ToF, a deficiency in physical development of P is revealed. Because of relatively small aged P being hospitalized and therapeutic 2-steped method, cases of deaths are reduced significantly. IPOC depends on patient’s age and presence of AP. Compared to initial predominant severe HF, it reduces to 1-2 by NYHA after surgery, which means postoperative favorable evolution, with a 11% risk of severe HF.