Small infundibulectomy versus ventriculotomy in tetralogy of Fallot
Main Article Content
Keywords
Heart defects, congenital, Thoracic surgery, Tetralogy of Fallot
Abstract
Background: the surgical correction of tetralogy of Fallot (TOF) is standardized on the way to close the septal defect, but differs in the way of expanding the right ventricular outflow tract (RVOT). The aim was to compare the early postoperative clinical course of the RVOT obstruction enlargement in classical ventriculotomy technique and the small infundibulectomy (SI).
Methods: it was done an analysis of the database of pediatric heart surgery service from 2008 to 2011. Patients with non-co
mplex TOF undergoing complete correction by classical ventriculotomy or SI were selected. Anova, c2 and Fisher statistical test were applied.
Results: the data included 47 patients, 55 % (26) male, mean age 43 months (6-172), classical ventriculotomy was performed in 61.7 % (29), this group had higher peak levels of lactate (9.07 versus 6.8 mmol/L) p = 0049, greater magnitude in the index bleeding/kg in the first 12 hours (39.1 versus 20.3 mL/kg) p = 0.016. Death occurred in 9 cases (31.03 %) versus one (5.6 %) in the SI group with p = 0.037; complications exclusive as acute renal failure, hemopneumothorax, pneumonia, permanent AV-block and multiple organ failure were observed.Conclusions: morbidity and mortality was higher in classical ventriculotomy group in comparison with SI. This is possibly associated with higher blood volume.
References
Starr JP. Tetralogy of Fallot: yesterday and today. World J Surg. 2010;34(4):658-68.
Kouchoukos NT, Blacksotone, Doty DB, et al., editores. Cardiac surgery. Third edition. Salt Lake City, Utah: Churchill Livingstone-Elsevier; 2003. p. 948-1062.
Miyamura H, Takahashi M, Sugawara M, et al. The long-term influence of pulmonary valve regurgitation following repair of tetralogy of Fallot: Does preservation of the pulmonary valve ring affect quality of life? Surg Today. 1996;26(8):603-6.
Lee JR, Kim JS, Lim HG, et al. Complete repair of tetralogy of Fallot in infancy. Interact Cardiovascular Thorac Surg. 2004;3 (3):470-4. Texto libre en http://icvts.oxfordjournals.org/content/3/3/470.long
Van Arsdell GS, Maharaj GS, Tom J, et al. What is the optimal age for repair of tetralogy of Fallot? Circulation. 2000;102(19 Suppl 3):III-123-9.
Munkhammar P, Cullen S, Jögl P, et al. Early age at repair prevents restrictive right ventricular (RV) physiology after surgery for tetralogy of Fallot (TOF), diastolic RV function after TOF repair in infancy. J Am Coll Cardiol. 1998;32(4):1083-7.
Al Habib HF, Jacobs JP, Mavroudis C, et al. Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons Database. Ann Thorac Surg. 2010;90(3):813-9.
Olivier-Ruiz JM, González-García AE. Síndrome hipoxémico crónico. Rev Esp Cardiol. 2009;9 (Supl E):13-22. Texto libre en http://www.revespcardiol.org/es/sindrome-hipoxemico-cronico/articulo/13146150/
Nollert G, Fischlein T, Bouterwek S, et al. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol. 1997;30(5):1374-83.
Hausdorf G, Hinrichs C, Nienaber CA, et al. Left ventricular contractile state after surgical correction of tetralogy of Fallot: risk factors for late left ventricular dysfunction. Pediatr Cardiol. 1990;11(2):61-8.
Seliem MA, Wu YT, Glenwright K. Relation between age at surgery and regression of right ventricular hypertrophy in tetralogy of Fallot. Pediatr Cardiol. 1995;16(2):53-5.
Ternestedt M, Wall K, Oddsson H, et al. Quality of life 20 and 30 years after surgery in patients operated on for tetralogy of Fallot and for atrial septal defect. Pediatr Cardiol. 2001;22(2):128-32.
Muñoz R, Laussen PC, Palacio G, et al. Changes in whole blood Lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: an early indicator of morbidity and mortality. J Thorac Cardiovasc Surg. 2000;119(1):155-62.
Morales DL, Zafar F, Heinle JS, et al. Right ventricular infundibulum sparing (RVIS) tetralogy of Fallot repair: a review of over 300 patients. Ann Surg 2009; 250(4):611-17.
Kirklin JW, Wallace RB, Mcgoon DC, et al. Early and late results after intracardiac repair of tetralogy of Fallot: 5-year review of 337 patients. Ann Surg. 1965;162(4):578-89. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476957/
Trimble AS, Morch JE, Froggatt GM, et al. Total intracardiac repair of the adult cyanotic tetralogy of Fallot: clinical experience and late follow-up. Can Med Assoc J. 1970;103(9):911-14. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1930593/
Hamilton DI, Di Eusanio G, Piccoli GP, et al. Eight years’ experience with intracardiac repair of tetralogy of Fallot: early and late results in 175 consecutive patients. Br Heart J. 1981;46:144-51. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC482620/
Fraser CD jr, McKenzie ED, Cooley DA. Tetralogy of Fallot: surgical management individualized to the patient. Ann Thorac Surg. 2001;71(5):1561-63.
Cheung EW, Wong WH, Cheung YF. Meta-analysis of pulmonary valve replacement after operative repair of tetralogy of Fallot. Am J Cardiol. 2010;106(4): 552-57.
Gil-Jaurena JM, Ferreirosa M, Castillo R, et al. Neoválvula pulmonar en la corrección del Fallot con parche transanular. Rev Esp Cardiol. 2010; 63(12):1438-43. Texto libre en http://www.revespcardiol.org/es/neovalvula-pulmonar-correccion-del -fallot/articulo/13188305/