THE 1ST OPEN-HEART CORRECTIONS OF TETRALOGY OF FALLOT - A 26-31 YEAR FOLLOW-UP OF 106 PATIENTS
THE 1ST OPEN-HEART CORRECTIONS OF TETRALOGY OF FALLOT - A 26-31 YEAR FOLLOW-UP OF 106 PATIENTS
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DOI：
10.1097/00000658-198610000-00017
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发表时间：
1986-10-01
影响因子：
9
通讯作者：
MOLLER, JH
中科院分区：
文献类型：
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作者：
LILLEHEI, CW;VARCO, RL;MOLLER, JH
法洛四联症于1954年8月31日成为一种可矫正的畸形，从该日至1960年，在明尼苏达大学接受开放性修复并出院的106例患者（年龄4个月至45岁）一直随访（99%完成）至死亡或26-31年（平均：23.7年，2424患者年）。本研究的目的是确定生存率，发病率，血流动力学，教育/就业程度，以及这些手术技术的关系。6例采用交叉循环，100例采用鼓泡式氧合器。该小组首次使用了室间隔缺损修补术、流出道根部、漏斗成形术、闭锁矫正术、缺血性停搏和起搏器等创新技术。21例（105例患者）在随访期间死亡：前10年死亡8例，10 - 20年死亡12例，20年以上死亡1例。死亡原因为突发（5）、意外（4）、充血性衰竭（2）、再次手术（2）、自杀（2）和其他（2）。30年生存率为77%。晚期并发症包括再次手术、5例心律失常和1例心内膜炎。30年时无再手术率为91%。62例患者的心脏再导管术仅发现10例残余分流。右室收缩压峰值< 40 mmHg（34例），41-60 mm（2例），61-70 mm（4例），71 mm以上（4例）。34名患者（32%）完成了大学学业，其中10名完成了研究生学业（5名硕士学位，2名M.D. 's，2 Ph.D.律师1人）。另外15人上了大学，9人获得了技术学校文凭。40例患者（18例男性，22例女性）有后代，其中82例（93%）活产，6例主要心脏缺陷（7.3%）。总之，在心脏直视手术早期接受治疗的这组患者中，完全修复术获得了极好的晚期结果。幸存者在教育和就业方面不受限制地过着生产性生活。发生的许多死亡/并发症现在都可以很容易地预防，这对这一代人来说是个非常好的预兆。
Tetralogy of Fallot became a correctable malformation on August 31, 1954, and from that date through 1960, 106 patients (ages 4 months.sbd.45 years) who underwent open repairs at the University of Minnesota and were discharged, have been followed (99% complete) until death or for 26-31 years (mean: 23.7 years, 2424 patinet years). The purpose of this study were to determine survival morbidity, hemodynamics, educational/employment attainments, and relation of these to surgical technics. Operations were done by cross circulation (6 patients) and bubble oxygenator (100 patients). This group had the first uses of patch ventricular septal defect closure, outflow root, infundibuloplasty, atresia correction, ischemic arrests, and pacemakers among other innovations. Twenty-one (of 105 patients) have died during the followup: eight deaths in the first 10 years, 12 between 10 and 20 years, and 1 > 20 years. The causes of death were sudden (5), accidental (4), congestive failure (2), reoperation (2), suicide (2), and other (2). Actuarial survival at 30 years was 77%. Late complications were test reoperations, five arrhythmias, and one endocarditis. Actuarial freedom from reoperations at 30 years was 91%. Cardiac recatheterizations in 62 patients disclosed only 10 with residual shunts. Peak right ventricular systolic pressures were < 40 mmHg (34 patients), 41-60 mm (2 patients), 61-70 mm (4 patients), > 71 mm (4 patients). Thirty-four patients (32%) completed college, ten of these completed graduate school (5 masters degrees, 2 M.D.''s, 2 Ph.D.''s, 1 lawyer). Fifteen others attended college, and nine received technical school diplomas. Forty patients (18 men, 22 women) had progeny, with 82 (93%) live births and six major cardiac defects (7.3%). In summary, complete repair gave excellent late results in this group cared for very early in the open heart era. Survivors led productive lives without restrictions in education and employment. Many of the deaths/complications that occurred are now easily preventable, which augurs extremely well for this generation.