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Predicted outcome after repair of tetralogy of Fallot by postoperative pressure ratio between right and left ventricle.
J Med Assoc Thai. 2006 Jan; 89(1):43-50.JM

Abstract

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 post-operative 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 TOF. 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.

Authors+Show Affiliations

Division of Cardiovascular Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. cvoravit@medicine.psu.ac.thNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16583580

Citation

Chittithavorn, Voravit, et al. "Predicted Outcome After Repair of Tetralogy of Fallot By Postoperative Pressure Ratio Between Right and Left Ventricle." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 89, no. 1, 2006, pp. 43-50.
Chittithavorn V, Rergkliang C, Chetpaophan A, et al. Predicted outcome after repair of tetralogy of Fallot by postoperative pressure ratio between right and left ventricle. J Med Assoc Thai. 2006;89(1):43-50.
Chittithavorn, V., Rergkliang, C., Chetpaophan, A., Vasinanukorn, P., Sopontammarak, S., & Promphan, W. (2006). Predicted outcome after repair of tetralogy of Fallot by postoperative pressure ratio between right and left ventricle. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 89(1), 43-50.
Chittithavorn V, et al. Predicted Outcome After Repair of Tetralogy of Fallot By Postoperative Pressure Ratio Between Right and Left Ventricle. J Med Assoc Thai. 2006;89(1):43-50. PubMed PMID: 16583580.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicted outcome after repair of tetralogy of Fallot by postoperative pressure ratio between right and left ventricle. AU - Chittithavorn,Voravit, AU - Rergkliang,Chareonkiat, AU - Chetpaophan,Apirak, AU - Vasinanukorn,Prasert, AU - Sopontammarak,Somkiat, AU - Promphan,Worakan, PY - 2006/4/6/pubmed PY - 2006/5/11/medline PY - 2006/4/6/entrez SP - 43 EP - 50 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 89 IS - 1 N2 - 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 post-operative 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 TOF. 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. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/16583580/Predicted_outcome_after_repair_of_tetralogy_of_Fallot_by_postoperative_pressure_ratio_between_right_and_left_ventricle_ L2 - http://www.diseaseinfosearch.org/result/2720 DB - PRIME DP - Unbound Medicine ER -