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KMID : 0364019910240070674
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Korean Journal of Thoracic and Cardiovascular Surgery
1991 Volume.24 No. 7 p.674 ~ p.684
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Clinical Review about Corrective Surgery of Tetralogy of Fallot
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조광현/Cho, Kwang Hyun
황윤호/이양행/박종원/정신현/최강주/Whang, Youn Ho/Lee, Yang Haeng/Park, Jong Weon/Jung, Shin Hyun/Choi, Kang Joo
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Abstract
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The surgical treatment of tetralogy of Fallot (TOF) was initiated by Blalock and Taussig in 1945 with the establishment of the subclavian artery to pulmonary artery anastomosis. In an imaginative and daring effort, in 1954, Lillehei and collaborators (1955) using con-trolled cross-circulation, carried out the first intracardiac repair of TOF by closing the ventricular septal defect (VSD) and relieving the pulmonary stenosis under direct vision.
Nowadays, total correction is the ideal operation for treatment of TOF and is accomplished with extracorporeal circulation. And the results of surgery for TOF have steadily improved over the years, thanks to important contributions of many surgeons. Nevertheless because of its protean physiologic and anatomic presentation, TOF continues to offer challenges to cardiologist and cardiac surgeons.
Thirty two cases of TOF have undergone total corrective surgery using extracorporeal circulation in the Department of Thoracic & Cardiovascular Surgery, Pusan Palk Hospital, Inje University, from Oct. 1985 to Feb. 1990. Cinical considerations were applied to these cases and the results were obtained as follows.
1. The heart lung machine used for extracorporeal circulation was Sarns 7000, 5-head roller pump, and the number and type of oxygenators were 10 of bubble type and 22 of membrane type. The mean bypass time was 148.9 minutes and the mean aortic cross clamp time was 123.8 minutes. The GIK (glucose-insulin-potassium) solution was used as cardioplegic solution for myocardial protection during operation.
2. 20 cases were male and 12 were female, the mean age was 8 years old and the mean body weight was 25Kg.
3. The preopertaive symptoms were cyanosis (29 cases), squatting (27 cases) and etc. The mean values of preoperative Hb., Hct., and SaO2 were 16.5 gm /dl, 50.3%, and 78.5%.
4. Combined anomalies were noticed in 16 cases (50%). Among them 10 cases were PFO and 6 cases were ASD.
5. The degree of aorta overriding were 25% in 5 cases, 2550% in 22 cases and above 5000 in 5 cases. The Dpa/Aa (ratio of diameter of pulmonary artery trunk to ascending aorta) were below 25% in 5 cases, 2550% in 10 cases, 5070% in 6 cases and above 75% in 11 cases.
6. The types of RVOT (right ventricular outflow tract) stenosis were valvular and infundibular in 14 cases (43.600), diffuse hypoplastic type in 12 cases (37.5%), infundibular in 5 cases, and valvular and supravalvular in 1 case.
7. One stage radical corrective surgery was applied to the all cases. In widening of the RVOT, 3 types of patches were used : MVOP (monocusp ventricular outflow patch, Polystan Bioprostheses) in 3 cases, knitted Dacron vessel patches in 2 cases, and double layer with bovine pericardium and woven Dacron prosthesis in 26 cases.
8. Postoperative complications were occurred in 15 cases. Among them, low output syndrome were occurred in 10 cases (31.3%) and 2 of them were expired postoperatively.
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