Surgical treatment of tetralogy of Fallot in symptomatic neonates and young infants
| Autor: | Dong Hee Kim, Bobae Jeon, Tae Jin Yun, Eun Seok Choi, Bo Sang Kwon, Chun Soo Park |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine medicine.medical_specialty 030204 cardiovascular system & hematology Young infants law.invention 03 medical and health sciences 0302 clinical medicine law Pulmonary regurgitation Cardiopulmonary bypass Humans Medicine Retrospective Studies Tetralogy of Fallot business.industry Palliative Care Infant Newborn Infant Left pulmonary artery Length of Stay medicine.disease Intensive care unit Surgery Survival Rate Stenosis Logistic Models Treatment Outcome medicine.anatomical_structure 030228 respiratory system Pulmonary valve Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 159:1466-1476.e2 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2019.10.172 |
| Popis: | Optimal management of tetralogy of Fallot in symptomatic neonates and young infants remains controversial.A retrospective review of 53 patients (26 male) with symptomatic tetralogy of Fallot who underwent primary repair (group 1, n = 22) or initial palliation (group 2, n = 31) within 2 months (60 days) after birth between 2005 and 2018 was performed. Subsequent repairs were performed in 29 patients at postpalliation 7.1 months in group 2 except for 2 interstage mortalities. Optimal early outcome was defined as no significant pulmonary stenosis or significant pulmonary regurgitation, and no reintervention within 12 months after repair.In group 2, median Z-score of the pulmonary valve annulus and McGoon ratio increased after palliation from -3.52 to -2.95 (P = .074) and from 1.31 to 1.93 (P .001), respectively. Pulmonary annulus preservation at repair and optimal early outcome were achieved in 38 patients (17/22, 77%, group 1; 21/29, 72%, group 2) and 26 patients (12/22, 55%, group 1; 14/29, 48%, group 2), respectively. On logistic regression analysis, initial Z-score of the pulmonary valve annulus was the only predictor of annulus preservation at repair (odds ratio, 1.715, P = .0204) and optimal early outcome (odds ratio, 1.583, P = .0259). The annulus preservation probability curve according to the initial postnatal Z-score of the pulmonary valve annulus of all patients with repair (n = 51) showed an annulus preservation probability less than 70% in 3 patients (3/22) in group 1 and greater than 85% in 8 patients (8/29) in group 2, signifying that the alternative strategy might have been beneficial for each subset.The surgical strategy for symptomatic tetralogy of Fallot should be individualized according to the initial size of the pulmonary valve annulus. |
| Databáze: | OpenAIRE |
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