Document Detail


Predicted outcome after repair of tetralogy of Fallot by postoperative pressure ratio between right and left ventricle.
MedLine Citation:
PMID:  16583580     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The surgical management of tetralogy of Fallot (TOF) has continued to evolve and there are now generally excellent early and long-term results following complete repair. OBJECTIVE: To investigate the early results of the authors' current surgical management of TOF by assessing the perioperative and early to intermediate follow-up period. The authors paid particular attention to the post-operative ratio of right ventricular to left ventricular systolic pressure (RVSP/LVSP), focusing on the presence of low cardiac output, intensive care unit (ICU) stay, prolonged of inotropic support and ventilation support time. STUDY DESIGN: Retrospective study. MATERIAL AND METHOD: Between June 2002 and August 2004, 31 consecutive patients underwent complete repair of TOF. Their mean age was 7.7 +/- 5.1 years (range, 2.9 to 25.3). A previous palliative shunt had been performed in 14 (45.2%) patients. Twenty-three patients (74.2%) were in NYHA FC II. Mean hematocrit and oxygen saturation were 50.9 +/- 10.25% and 80.5 +/- 8.6%, respectively. Mean preoperative ratio of RVSP/LVSP was 1.1 +/- 0.15. The operative approach was transatrial/transpulmonary, and 17 (54.8%) patients required a transannular patch. An extracardiac valve conduit was necessary in 3 (9.7%) patients with pulmonary atresia. RESULTS: There were no operative or late deaths. Two cases were reoperated from cardiac tamponade. Mean postoperative ratio of RVSP/LVSP was 0.53 +/- 0.16. Median ICU and hospital stays were 2.2 and 11 days, respectively. Presence of low cardiac output and prolonged inotropic support were significantly (P < 0.05) related to a RVSP/LVSP ratio of more than 0.5. At median follow-up of 6 months, 29 (93.5%) patients were asymptomatic and all patients were free of significant residual lesion. CONCLUSION: The authors' early results in complete repair of TOF patients are acceptable with a low incidence of morbidity. A postoperative RVSP/LVSP ratio of more than 0.5 was significantly associated to adverse outcome. Late complications may, however, develop, and long term follow-up for early detection of any such complications is essential.
Authors:
Voravit Chittithavorn; Chareonkiat Rergkliang; Apirak Chetpaophan; Prasert Vasinanukorn; Somkiat Sopontammarak; Worakan Promphan
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the Medical Association of Thailand = Chotmaihet thangphaet     Volume:  89     ISSN:  0125-2208     ISO Abbreviation:  J Med Assoc Thai     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-04-04     Completed Date:  2006-05-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7507216     Medline TA:  J Med Assoc Thai     Country:  Thailand    
Other Details:
Languages:  eng     Pagination:  43-50     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. cvoravit@medicine.psu.ac.th
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Cardiac Output, Low / complications
Child
Child, Preschool
Female
Heart / physiopathology*
Heart Ventricles / physiopathology
Humans
Male
Postoperative Complications
Postoperative Period
Retrospective Studies
Tetralogy of Fallot / physiopathology,  surgery*
Ventricular Pressure / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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