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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2011 June;24(3):133-7
Surgeries for cardiovascular anomalies associated with tetralogy of Fallot
Zhong J Q. 1, Li Z. 1, Xiao Y. 2
1 Department of C.ardiovascular Surgery, Daping Hospital, Third Military Medical University, Chongqing, China;
2 Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
AIM: This study was undertaken to evaluate the validity of surgical treatment of cardiovascular anomalies associated with tetralogy of Fallot.
METHODS:From January 1999 to July 2009, 136 consecutive patients with tetralogy of Fallot and associated cardiovascular anomalies were admitted to my hospital. The associated anomalies consisted of 15 different forms of cardiovascular malformations, for a total of 205 patient-anomalies, including persistent pulmonary atresia, anomalous origins of coronary arteries, absent left pulmonary artery, complete atrioventricular septal defect, supravalvular mitral stenosis, Cantrell syndrome, absent pulmonary valve syndrome, left pulmonary artery originating from ascending aorta, partially unroofed coronary sinus, et al. Corrective or palliative repair of tetralogy of Fallot and surgeries for the associated anomalies were performed on all patients.
RESULTS:Mean cardiopulmonary bypass time and mean ascending aorta cross-clamp time were 126.7±48.5 minutes and 82.6±27.4 minutes, respectively. Postrepair mean pulmonary transannular pressure gradient was 10.6±3.8 mmHg, and mean PRV/LV was 0.44±0.12. The postoperative mean maximal dosage of dopamine administered was 6.2±2.1μg/kg/min. Refractory low cardiac output syndrome occurred in 9 patients (6.6%). Early postoperative mortality was 2.9% (4 patients). Survival (including early death) at 1, 5, and 10 years was 97.1%. Of 132 patients survived primary surgery, 119 (90.2%) were in New York Heart Association functional class I, and 13 (9.8%) in class II at the latest follow-up.
CONCLUSION:Cardiovascular anomalies associated with tetralogy of Fallot make surgery difficult and risky. Optimal surgical treatment of the associated anomaly and tetralogy of Fallot, and appropriate perioperative management play pivotal roles in achieving optimal outcomes.