Routine primary repair of tetralogy of Fallot in neonates and infants less than three months of age.
Routine primary repair of tetralogy of Fallot in neonates and infants less than three months of age.
复制标题
新生儿和三个月以下婴儿法洛四联症的常规初次修复。
DOI：
10.1016/0003-4975(95)00732-6
复制
发表时间：
1995
期刊：
影响因子：
--
通讯作者：
F. Hanley
中科院分区：
文献类型：
--
作者：
V. Reddy;J. Liddicoat;D. McElhinney;M. Brook;P. Stanger;F. Hanley
尽管法洛四联症的一期修补术越来越多地在婴儿期进行，但完全修复术一般只在选定的有症状的新生儿身上进行。方法1992年7月至1995年3月，连续30例法乐氏四联症的新生儿和婴幼儿接受了常规一期修补术。I组(n=10)：法洛四联症合并肺动脉闭锁或重度肺狭窄患者各5例，均依赖导管，在新生儿期修复。II组(n=11)，无症状，动脉血氧饱和度在75%~90%之间(肺血流量充足)。Ⅲ组(n=9)为粉红色法洛四联症患者(动脉血氧饱和度<90%)。II组和III组的患者择期在出生后2个月左右进行修补术。结果右室收缩期峰压与左心室收缩期峰压的比值与肺动脉分支大小无关(p=0.96)。1例患者在术后2个月死亡，尽管血流动力学良好，但由于家族性分叉性淋巴水肿综合征导致无法控制的弥漫性皮下水肿。没有晚期死亡病例。中位随访时间为19个月，1例患者接受了分支肺动脉球囊扩张术。超声心动图显示3例患者右室-肺动脉压差为30~60 mm Hg。结论婴幼儿早期常规一期修补术可获得良好的早期和中期效果，无论年龄、症状状态、冠状动脉解剖以及分支正常的肺动脉分支的大小。
BACKGROUNDAlthough primary repair of tetralogy of Fallot is increasingly undertaken in infancy, complete repair is generally performed in only selected symptomatic neonates.METHODSFrom July 1992 through March 1995, 30 consecutive neonates and young infants with tetralogy of Fallot underwent routine primary repair. Group I (n = 10) consisted of patients with tetralogy of Fallot and pulmonary atresia (n = 5) or severe pulmonary stenosis (n = 5) who were duct dependent and were repaired in the neonatal period. Group II (n = 11) consisted of patients who were asymptomatic with arterial oxygen saturation between 75% and 90% (adequate pulmonary blood flow). Group III (n = 9) consisted of patients with “pink” tetralogy of Fallot (arterial oxygen saturation >90%). Patients in groups II and III were electively scheduled for repair at about 2 months of age.RESULTSThe postrepair peak systolic right ventricularto-peak systolic left ventricular pressure ratio did not correlate (p = 0.96) with the branch pulmonary artery size. One patient died 2 months after operation, despite good hemodynamics, of uncontrollable diffuse subcutaneous edema due to familial distichiasis lymphedema syndrome. There were no late deaths. At a median follow-up of 19 months, 1 patient underwent balloon dilation of branch pulmonary arteries. Follow-up echocardiography revealed a 30 to 60 mm Hg right ventricleto-pulmonary artery gradient in 3 patients.CONCLUSIONSExcellent early and midterm results can be accomplished with routine primary repair of tetralogy of Fallot in early infancy regardless of age, symptomatic status, coronary anatomy, and the size of branch pulmonary arteries as long as they arborize normally.