Predicted outcome after repair of tetralogy of Fallot by postoperative pressure ratio between right and left ventricle
Chittithavorn, V.; Rergkliang, C.; Chetpaophan, A.; Vasinanukorn, P.; Sopontammarak, S.; Promphan, W.
Journal of the Medical Association of Thailand 89(1): 43-50
2006
ISSN/ISBN: 0125-2208 PMID: 16583580 Document Number: 2427
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 postoperative 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 TOE 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.