Definitive Repair of Tetralogy of Fallot:A Review of 104 Cases

Abstract

Definitive repair of tetralogy of Fallot was performed on 104 children, including 42 younger than 2 years (24 < 1 year and 7 < 6 months). Twenty-two had previous shunt. Transannular patching was required in 60 cases and conduit grafts in two. During 60-day postoperative observation, five patients died. Of the 99 survivors, 93 recovered without complications, three required prolonged mechanical ventilation, two reoperation and one balloon dilatation for residual left pulmonary artery stenosis. Morbidity and mortality were not significantly higher in the patients younger than 12 months, although transannular patching was more common in that age group. Previous shunt operations entailed higher prevalence of distal stenosis and distortion of the pulmonary arteries, which often necessitated surgical repair, and also considerably increased postoperative morbidity and mortality. As the outcome in definitive repair of Fallot's tetralogy is favourable, even in patients younger than 12 months, and as preliminary shunt operations are associated with heightened perioperative morbidity and mortality rates in definitive repair, we advocate the definitive operation for all young patients with severe cyanosis or cyanotic spells.

Distinctive Hemodynamics in the Immediate Postoperative Period of Patients with a Longer Cardiac Intensive Care Stay Post-Tetralogy of Fallot Repair

“…Both groups had none or minimal residual VSD after repair and no significant difference in median postoperative RVOT gradient (LSG 22 mm Hg [8,50] (Table 1). Patients staying longer than 2 days in the CICU had a higher inotropic score (LSG 11 [2,40] vs. SSG 8 [3,20], P = .02) and a higher CVP (LSG 10 mm Hg [4,18] vs. SSG 9 [3,13], P = .05) on arrival to the CICU ( Figure 1). These groups also differed in hemodynamics and clinical course observed over the total CICU stay with LSG patients having a higher average inotropic score, average CVP, and average fluid requirement.…”

“…Researchers have identified two distinct groups when it comes to postoperative ToF patients . Those with prolonged stay tend to have a higher need of inotropes, ventilator support, fluid requirement, pleural effusions, and increased chest tube drainage due to development of RV restriction .…”

“…Researchers have identified two distinct groups when it comes to postoperative ToF patients. 3,4,8 Those with prolonged stay tend to have a higher need of inotropes, ventilator support, fluid requirement, pleural effusions, and increased chest tube drainage due to development of RV restriction. 5,8,11 Some demonstrate resolution of this physiology by ninth postoperative day, 5 while others have implicated long-term morbidity due to early postoperative RV restriction.…”

“…Early prediction of length of cardiac intensive care unit (CICU) stay can be useful for optimizing management strategies, counseling, and even planning for patients needing critical care services in the future . Of all the patients who undergo surgical correction of tetralogy of Fallot (ToF), majority have a largely uneventful recovery postoperatively . However, some patients have a longer duration of stay in the CICU which can be attributed to poor postoperative hemodynamics.…”

“…1,2 Of all the patients who undergo surgical correction of tetralogy of Fallot (ToF), majority have a largely uneventful recovery postoperatively. 3,4 However, some patients have a longer duration of stay in the CICU which can be attributed to poor postoperative hemodynamics. This is usually characterized by pleural effusions, ascites, and a prolonged need for mechanical and pharmacological support in the CICU.…”