82例大龄法洛四联症患者的手术治疗

Perioperative treatment of tetralogy of Fallot in adult

目的 :探讨大龄法洛四联症患者的围手术期治疗。 方法 :回顾性分析 1995年 5月至 2 0 0 2年 12月施行手术治疗的 82例大龄法洛四联症患者 ,均采用右心室纵切口 ,彻底疏通右心室流出道 ,涤纶补片修补室间隔缺损 ,人造血管单纯加宽右心室流出道 2 2例 ,余均采用带单瓣的跨瓣环补片 ,合并畸形者同期手术。 结果 :死亡 2例 ,病死率为 2 .4 3% ;1例死于顽固的低心排血量综合征 ,1例死于气管切开后的反复出血 ,余 80例痊愈出院。随访 6个月至 7年 ,恢复良好。 结论 :大龄法洛四联症患者均为大室间隔缺损 ,而且缺损边缘心肌较脆。为防止缝合时切割心肌 ,宜采用间断缝合外加长毡条加固。大龄法洛四联症患者应及早手术矫正 ,近远期效果好。

Objective: To summarize the experience of perioperative treatment of TOF(tetralogy of Fallot) in adult. Methods: 82 adult patients receiving total correction of TOF from May 1995 to Dec 2002 were analysed. The vertical right ventricular incision was made to close the VSD (ventricular septal defect) with Dacron patch and to relieve the RVOT (right ventricular outflow tract) obstruction, and corrected other abnormalities. Twenty-two patients the outflow chamber was enlarged with simple PTFE (polytetrafluoroethylene) patch , and others patients the transannular patch were constructed. Results:One case died of low cardiac output syndrome, the other died of bleeding after tracheotomy, the mortality is 2.43%. Eighty cases were recovered with a follow-up periods being from 6 months to 7 years. Conclusion: Adult patients of TOF had myocardium hypertrophy and fibrosis affecting the cardiac function with liability to cause severe low cardiac output syndrome after operation. proper resection of the myocardium for relieving RVOT is justifiable. In adult TOF case the VSD was usually large and the edge was friable. Closing VSD with interrupted sutures,and with a long felt for preventing the tearing of the muscle was done. It is suggested that adult TOF must receive earlier surgical correction for achieveing better outcomes.