Is early primary repair for correction of tetralogy of Fallot comparable to surgery after 6 months of age?

Vohra, Hunaid A.; Adamson, Louise; Haw, Marcus P.

doi:10.1510/icvts.2008.180083

Cited by 30 publications

(27 citation statements)

References 8 publications

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“…Yayınlarda TOF'lu hastalarda erken dönem tam düzeltme ile geç dönem tam düzeltme karşılaştırılmıştır (26,27). Mortalite ve yeniden girişim gereksinimi konusunda çalışmamıza benzer şekil-de fark bulunmamıştır (25).…”

Section: Discussionunclassified

“…Mortalite ve yeniden girişim gereksinimi konusunda çalışmamıza benzer şekil-de fark bulunmamıştır (25). Ancak bizim çalışmamızın tersine diğer çalışmalarda özellikle 3 aydan küçük çocuklarda yoğun bakımda kalış süresi, mekanik solunum desteği gereksinimi, postoperatif inotrop destek ihtiyacı yüksek bulunmuştur (19,26,27). Ancak bizim çalışmamızda ameliyat edilen en küçük çocuk 5 aylık olduğundan yukarıdaki çalışmalar gibi üç yaş altı hasta grubunun sonuçlarını karşılaştırma imkanı olmamıştır.…”

Section: Discussionunclassified

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Determinants of short-term mortality and morbidity after the complete repair of tetralogy of Fallot in infant groups under 12 months and one-four years of age

Şaşmazel¹,

Fedakar²,

Baysal³

et al. 2010

Anadolu Kardiyol Derg

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Fallot tetralojili on iki ay altı infantlar ile bir-dört yaş arası çocuk hasta gruplarında tam düzeltme ameliyatı sonrasında kısa dönem mortalite ve morbiditenin belirleyicileriDeterminants of short-term mortality and morbidity after the complete repair of tetralogy of Fallot in infant groups under 12 months and one-four years of age Özgün Araşt›rma Original Investigation 544Yaz›şma Adresi/Address ABSTRACTObjective: In patients with tetralogy of Fallot, infants less than 12 months old and children between one and four years old were compared after total repair surgery for determination of outcome of surgery, risk factors influencing mortality and morbidity. Methods: Fifty-two patients with tetralogy of Fallot between five months and four years of ages were included into the study. The patients were divided into two groups depending on their ages; Group 1; one year old and younger (n=21) whereas, group 2; one and four years old (n=31). Statistical analysis was performed using Mann-Whitney U, Chi-square or where appropriate Fisher's exact tests and logistic regression analysis was applied for determination of predictors of mortality.Results: The parameters that were different between two groups include; age (Group 1; 10.00±1.67 months and Group 2; 2.39±0.77 years, p<0.001), weight (Group 1; 9.74±2.23 kg, Group 2; 11.97±1.78 kg, p<0.001), McGoon ratio (Group 1; 1.94±0.29, Group 2; 2.19±0.27, p=0.001). Mortality is found in 3 patients in group 1 (14.2%) whereas, in five patients in group 2 (16%) and the difference was not statistically significant. In group 2 in only one patient (0.03%) had complete atrioventricular block and required permanent pacemaker implantation. When patients were compared according to groups with and without mortality, the significant differences were found in following variables: peritoneal dialysis (p=0.001), pleural effusion (p=0.02), right ventricular pressure (p=0.001) and right ventricle/aorta pressures ratio (p=0.001). However, none of these risk factors had significant value in prediction of mortality. GirişFallot tetralojisi (TOF) tüm doğumsal kalp hastalıklarının %10'nu oluşturur ve siyanotik kalp hastalıklarının da en başta gelenidir (1). Fallot tetralojisinin tedavisi cerrahidir. Tam düzelt-me yapılan TOF'lu hastaların %85'inin erişkin çağa ulaşabildikle-ri gözlemlenmektedir (2). Eskiden tam düzeltme için iki yaşına kadar beklemek tercih edilirken, son 30 yıllık süreçte eğer pulmoner yatak uygunsa, bir yaşından önce tam düzetme yapılmak-tadır. Erken dönemde tam düzeltme yapılması, iki aşamalı ameliyatın getirdiği riski ortadan kaldırır. Pulmoner arterlere ve akciğer parankimine erken dönemde normal kan akımını sağlayarak, kronik hipokseminin etkilerinden korur. Sağ ventrikül önündeki basınç yükü kalktığından sağ ventrikül hipertrofisi geriler. BarattBoyes (3) 1969'da, Castañeda ve ark. (4) 1972'de erken dönemde tam düzeltme ameliyatı sonrası iyi sonuçlarını bildirmişlerdir (5). Bu çalışmada TOF'lu 12 ay altı infantlar ile bir-dört yaş arası çocuk hasta gruplarında tam düzeltme am...

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Section: Discussionunclassified

Determinants of short-term mortality and morbidity after the complete repair of tetralogy of Fallot in infant groups under 12 months and one-four years of age

Şaşmazel¹,

Fedakar²,

Baysal³

et al. 2010

Anadolu Kardiyol Derg

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“…In large centres worldwide, correction is performed between six and nine months of age 5. However, in developing countries, early repair may be difficult due to many factors, including facilities for diagnosis, cultural background of patients, and availability of surgical centres.…”

Section: Introductionmentioning

confidence: 99%

Late surgical treatment of tetralogy of Fallot

Tchoumi¹,

Ambassa²,

Giamberti³

et al. 2011

CardioVascular Journal of Africa

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AimTo study early post-operative results and follow up of patients over a year old, operated on for tetralogy of Fallot (ToF).MethodsThis retrospective analysis included 22 patients (14 male and eight female) with a mean age of 9.18 ± 6.5 years (range 13.5 months to 26 years), who underwent complete repair of ToF between April 2003 and June 2009. Data from patients’ records, pre-operative cardiac catheterisation studies, operative intervention, and pre-operative and postoperative two-dimensional echocardiographic studies were reviewed. All patients underwent complete repair including closure of ventricular septal defect (VSD). A trans-annular patch was used in 12 patients while an infundibular patch was used in 10 others. Patients were evaluated one, three, six and 12 months after surgery, and annually thereafter. The duration of follow up was from eight months to six years post surgery.ResultsClassical ToF was found in 10 patients. Twelve cases had associated anomalies: two patients with hypoplastic pulmonary artery branches, two with arterial duct malformations, and eight had proximal stenosis of the left branch of the pulmonary artery. NHYA class distribution was as follows: class I: two patients; class II: five subjects; class III: 10 patients; class IV: five subjects. The mean stay in hospital was 15 ± 7 days. Two patients (9%) died during the early post-surgical period. At a mean follow-up interval of 32 ± 9 months, all patients were asymptomatic and in NYHA class I. No late deaths occurred. In three patients, we registered isolated monomorphic ventricular extrasystoles. The right ventricle outflow tract (RVOT) pressure gradient was 29 ± 1.5 mmHg in the acute post-surgical period and it did not change significantly during follow up. The right ventricular function was defined as normal in 95% of the patients in the study and was mildly depressed in 5%.ConclusionEven if treated later in life, our study showed very good surgical results of patients with ToF.

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“…As for repair in the neonatal age, there are controversial opinions [37]. Patients under 3 months of age are linked to longer hospitalization and ventilation with the increased need of inotropic agents compared to the population over 6 months of age [38]. Modified palliative Blalock-Taussig shunting is still agreed on as useful for complex cases of patients with anomalous coronary arteries or multiple ventricular septal defects [39].…”

Section: Role Of Timing and Techniques Of Surgical Repairmentioning

confidence: 99%

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Grigaliūnas

Gumbienė

Valevičienė

et al. 2015

Seminars in Cardiovascular Medicine

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SummaryTetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart defect. Over the last century, the life expectancy of TOF patients has significantly improved. This, however, has brought new challenges both to patients and their health-care providers, the main of them being late arrhythmia. Ironically, late arrhythmia is predominantly generated due to the fibrotic scars caused by the life-saving surgical repair. Once the first two mainly arrhythmia-free decades after the repair pass, the risk of developing late arrhythmia and, therefore, SCD becomes substantial. Consequently, young adults with repaired Tetralogy of Fallot (rTOF) require careful outpatient monitoring.There have been many attempts to predict the risk of life-threatening arrhythmia in rTOF patients. This has led to the defining of various risk factors, ranging from the widely used QRS prolongation to novel predictors, derived from cardiac magnetic resonance (CMR) based anatomical findings (left ventricular dyssynchrony indexes, right ventricular output tract akinetic length, right ventricular mass-to-volume ratio). The latter predictors have recently established CMR as a tool of high significance in evaluation of rTOF patients.Although the role of Holter monitoring findings in rTOF patient-assessment remains unclear, it may be useful in those who are 25 years and older. Implantable cardioverter-defibrillator (ICD) implantation is the first-line treatment for secondary prevention of sudden cardiac death (SCD). rTOF patients suffer from the highest rate of inappropriate and the lowest rate of appropriate ICD shocks, when compared to other congenital heart diseases. As a consequence, ICD implantation for primary SCD prevention should be carefully weighed. Catheter-based ablation therapy leads to high rate of initial success when abolishing monomorphic ventricular tachycardia and intra-atrial reentrant tachycardia, however recurrence rates remain high. Seminars in Cardiovascular Medicine

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Is early primary repair for correction of tetralogy of Fallot comparable to surgery after 6 months of age?

Cited by 30 publications

References 8 publications

Determinants of short-term mortality and morbidity after the complete repair of tetralogy of Fallot in infant groups under 12 months and one-four years of age

Determinants of short-term mortality and morbidity after the complete repair of tetralogy of Fallot in infant groups under 12 months and one-four years of age

Late surgical treatment of tetralogy of Fallot

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

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