法乐氏四联症外科治疗及术后低心排诱因探讨

Study on Predisposing Factors of Low Cardiac Output Syndrome after Corrective Surgery for Tetralogy of Fallot

本文总结107例法乐氏四联症治疗经验。1例采用人工血管行升主动脉与主肺动脉分流,其余均施行一期矫正术。其中1例用带瓣导管作右心室-肺动脉重建通道,手术死亡率13％。低心排综合症发生率24％。本文对其产生低心排诱因进行分析,发现病情重,右室流出道改造不满意所致的右室残余高压是引起低心排和死亡的主要因素。

One hundred and seven cases of tetralogy of Fallot (TOF) were surgically corrected in this institute in the period from Jan 1983 to Dec 1989. Adequate corrective procedures were performed in 106 cases and aorto-pulmo-nary shunt with 1.2 Dacron tube in one. The corrective procedures employed included simple intracardiac repair in 18, subpulmonary RV outflow patch in 50, transannular RV outflow patch in 37, and RV-PA coronary conduit in 1 because of anomalous right coronary artery. The operative mortality rate was 13% , and the main complication was low cardiac output syndrome (LCOS) , which occurred in 26 cases (24%) .It was found that the predisposing factors of LOS after corrective surgery for TOF were serious clinical manifestations of the patient before operation, and residual right ventricular outflow tract obstruction due to improper repair of the right ventricular outflow tract, which were fatal in some cases.