Background The benefits of surgical correction of adult tetralogy of Fallot are well known. The current recommendation is for total correction regardless of age. This study analyzed perioperative factors affecting early outcome after corrective surgery in adulthood in the current era. Methods This was a retrospective chart review of 40 consecutive patients over 18 years of age who underwent total correction of tetralogy of Fallot from September 2006 to June 2013. Patients with pulmonary atresia and absent pulmonary valve were excluded. The mean age at surgery was 26.60 ± 8.69 years (range 18–49 years). Results The mean intensive care unit stay was 3.30 ± 2.29 days (range 0.75–12 days) and hospital stay was 9.97 ± 3.39 days (range 7–22 days). Mortality was 5% (2/40). Multiple parameters indicating immediate postoperative outcomes and their relationships to selected pre-, intra-, and postoperative factors were analyzed. Multivariate analysis showed that postoperative right ventricular dysfunction had a significant influence on mortality ( p < 0.001) and hospital stay ( p = 0.01). Performing zero-balance ultrafiltration decreased the need for renal replacement therapy ( p = 0.034), duration of ventilation ( p = 0.009), incidence of low cardiac output ( p = 0.006), intensive care unit stay ( p = 0.01), and hospital stay ( p = 0.009). Conclusions Total correction of tetralogy of Fallot is a safe option for presentations as late as adulthood. The protective effect of zero-balance ultrafiltration on postoperative morbidity needs to be reassessed in larger studies.
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We hereby present a three-year-old girl, previously asymptomatic, who developed rapid onset tachycardia, hypotension and cardiorespiratory arrest following an episode of respiratory tract infection. The patient was treated with anti-arrhythmic drugs, inotropes, and cardioversion after being diagnosed as atrial tachycardia, but the rhythm did not revert to sinus rhythm. Due to deteriorating condition patient was put on extra corporeal membrane oxygenation (ECMO) and supported for 131 hours along with supportive and IVIG treatment. After improvement in ejection fraction, patient was weaned off ECMO. The rhythm reverted to sinus after three days of admission and antiarrhythmics were gradually tapered. Patient was discharged on 17th day of admission in a stable condition with an ejction fraction of 58%. Conclusion: Timely extracorporeal membrane oxygenation (ECMO) support in fulminant acute myocarditis (FAM) with refractory atrial tachycardia and shock due to myocarditis, along with medical treatment could prevent lethal outcomes. IJCRI publishes
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