ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Our short and mid-term results of primary repair in infants less than one year of age with tetralogy of Fallot
Ahmet Şaşmazel1, Ayşe Baysal2, Ayşe Yıldırım3, Ali Fedakar1, Buğra Onursal1, Fuat Büyükbayrak1, Hasan Sunar1, Rahmi Zeybek1
1Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul
2Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Anestezi Kliniği, İstanbul
3Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Pediyatrik Kardiyoloji Kliniği, İstanbul
Background: This study evaluated the short- and mid-term effects of primary surgical repair in patients less than 12 months of age with tetralogy of Fallot.

Methods: Twenty-one patients (10 girls, 11 boys; mean age 10.0±1.7 months; range 7.0 to 12.0 months) with tetrology of Fallot, who underwent primary repair surgery between June 2007 and June 2009, were included in the study. The patients were divided into two groups as group S (survived group, n=18) and group M (mortality group, n=3). The retrospectively evaluated parameters include; cardiopulmonary bypass time, cross-clamp time, mechanical ventilation time, intensive care unit stay, the presence of plevral effusion, clinical follow-ups, and mortality and morbidity factors. Right ventricular and aortic systolic pressure ratios were measured. During operation, ventricular septal defect was closed with artificial patch via transventricular approach and right ventricular outflow tract was reconstructed with gluteraldehyde-treated pericardial patch in all patients.

Results: The mean hematocrit value was 53.6±2.8. Preoperative echocardiografic evaluations revealed that right ventricule to pulmonary artery gradient was higher in the group M (p=0.047). The short-term (<1 months) mortality rate was 9.52%. The mean follow-up period was 10.8±2.6 months. The relationships between independent variables and both groups were evaluated using correlation analysis. A significant correlation was found between group M and intensive care unit stay (p=0.004; r=0.59), peritoneal dialysis (p=0.02; r=0.49) and right ventricle aortic systolic pressure gradient (p=0.02; r=0.48). Echocardiographically, one patient had moderate pulmonary regurgitation and a gradient of 50 mmHg in the right ventricular outflow tract postoperatively. In one patient permanent pacemaker was placed due to complete atrioventricular block. The rest of our patients were in New York Heart Association Class I.

Conclusion: Primary correction of tetralogy of Fallot in patients of less than one years of age can be performed with an acceptable risk. We believe that, compared to the palliative procedures, primary repair provides physiological conditions that are close to normal by establishing normal blood flow to lung parenchyma in the early stages of life.

Keywords : Congenital heart surgery; infant; primary repair; tetralogy of Fallot
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