Optimisation of surgical repair of Tetralogy of Fallot

Abstract

The aim of study was the evaluation of the surgical treatment of the Tetralogy of Fallot (TF), to emphasize the technical and age particularities, in order to develop a clear tactic in the future treatment and to study the opportunity of this patients in activity. To achieve our objective we have analyzed the experience of the last 10 years, during which 182 patients were operated with TF (to the 61 patients have been made the palliative procedures and to the 121 - the radical correction). The patient’s age was between 3 and 42 years. The data were studied from the observation and outpatient files of patients evaluated in the dynamic after ECHOC and clinical data. The standard preoperative patients have had performed: ECG, ECHOC, before being indicated the cardiac cateterism and angiography. The ECHOC investigations have been made repeatedly over 10 days postoperative, 1 month, 3 months, 6 months and then once a year to analyze the dynamics of the remaining gradient caused by the obstruction of right ventricular output tract (ORVOT) and material used in plastic right ventricular output tract (RVOT) and pulmonary artery (PA). Between the patients with radical correction 43 were re-operated after the inter-systemic anastomosis in the history, to 2 of which were performed 2-stage palliative, to one - 3 steps out in order with unfavourable pulmonary artery anatomy. In 2 cases for the anastomosis ligature and plastic of AP branch circulatory arrest was performed. For the ventricular outlet tract plasty have been used these methods: patch of outlet tract ventricular in 38.8%, 47.9% transanular patch, implantation of homograph 4.1%, 4.96% suture of the tract, corrected by atrial and pulmonary artery approach in 4.24% cases. The transanular patch has been applied in patients with intersystemic anastamosis previously in 45% cases and in 52% cases of primary radical correction. The relationship between ventricular and aortic pressure after the correction was 0.53 in the group with transanular patch compared with 0.45 in the group with resection of the ring. Postoperative lethality represented 20.6%, with its subsequent reduction in the last 2 years up to 4.1%. The favorable functional result was obtained in patients with implanted homograph and suturing the right ventricular outflow tract. The regurgitation at the pulmonary artery was observed in patients with transanular patch plasty which presents a risk factor for repeated surgery. The surgical treatment depends of two important things: proper removal ORVOT without compromising pump function and closure of VSD. The application of the intersystemic anastomosis as first stage, creating favorable conditions for radical correction, reduces the need to transanular patch application. The radical correction applied for children under 3 years cause growth of postoperative lethality in the absence of the necessary endowment profile sections.