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Predicted Outcome after Repair of Tetralogy of Fallot by Postoperative Pressure Ratio between Right and Left Ventricle


Voravit Chittithavorn MD*, Chareonkiat Rergkliang MD*,
Apirak Chetpaophan MD*, Prasert Vasinanukorn MD*,
Somkiat Sopontammarak MD**, Worakan Promphan MD**

* Division of Cardiovascular Thoracic Surgery, Department of Surgery, Faculty of Medicine,
Prince of Songkla University, Hatyai, Songkhla
** Division of Pediatrics Cardiology, Department of Padiatrics, Faculty of Medicine,
Prince of Songkla University, Hatyai, Songkhla


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.

Keyword : Tetralogy of fallot (TOF), Right ventricular systolic pressure (RVSP), Left ventricular systolic pressure (LVSP), Early results

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