Staged Procedures versus Primary Repair for Tetralogy of Fallot and Small Left Ventricle

Abstract

<jats:p>&lt;p&gt;&lt;b&gt;Introduction:&lt;/b&gt; This study was conducted to address whether staged surgical intervention or primary repair would be preferred for treating patients with tetralogy of Fallot and small left ventricle.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; We retrospectively assessed 28 patients with tetralogy of Fallot and small left ventricle at the Chinese PLA 208th Hospital, Changchun, between January 2005 and December 2008. Of this cohort, 11 patients had undergone a systemic-to-pulmonary arterial shunt with a polytetrafluoroethylene interposition graft (off pump), followed by ancillary repair procedures as a surgically staged group; the remaining 17 patients underwent primary intracardiac repair via cardiopulmonary bypass. The oxygen level as measured by pulse oximetry (SpO2), the McGoon ratio, and the left ventricular end-diastolic volume index (LVEDVI) were measured before shunt procedures and at 6 to 18 months afterwards. All data were analyzed statistically with the paired Student t test. The 2 groups were compared with respect to LVEDVI values and McGoon indices at baseline by the independent t test.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; None of the patients died as a direct result of the surgery, but 1 fatality due to pneumonia occurred 4 months after shunting. Mean postshunt values for SpO2, the McGoon ratio, and the LVEDVI increased significantly from 76.8% � 9.0% to 87.5% � 2.4% (P &lt; .01), from 1.42 � 0.27 to 1.62 � 0.32 (P &lt; .05), and from 20.1 � 7.0 mL/m2 to 34.3 � 7.4 mL/m2 (P &lt; .01), respectively. Nine patients were fully repaired within the 6- to 18-month time frame after shunting, while 1 patient awaited definitive surgery for pulmonary hypoplasia. In the primary-repair group, in which the increases the LVEDVI and McGoon ratio were comparatively higher, 1 patient died of hypoxemia.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusion:&lt;/b&gt; A LVEDVI 20 mL/m2 may be an indication for primary repair in patients with tetralogy of Fallot. With values &lt;20 mL/m2, staged procedures (ie, shunt with a polytetrafluoroethylene interposition graft) can promote left ventricle development and allow safe transition to the final repair.&lt;/p&gt;</jats:p>

Potential association of long noncoding RNA HA117 with tetralogy of Fallot

“…Reduced values of the McGoon ratio, Nakata index and LVEDVI are predictors of adverse outcomes. 5 , 17 , 18 …”

“…McGoon ratio, Nakata index, LVEDVI, LVEF and SPO 2 were divided into two groups each using cut-off values 1.2, 150 mm 2 /m 2 , 30 mL/m 2 , 50 and 80, respectively according to previously published studies. 5 …”

“… 3 Deformities of the right ventricular outflow tract (RVOT), especially in pulmonary artery, are observed in almost all TOF patients, 4 and the indexes of severity of RVOT dysplasia such as McGoon ratio, Nakata index and left ventricular end-diastolic volume index (LVEDVI) are predictors of prognosis. 5 A relationship between abnormal differentiation of cardiomyocytes and deformities of the RVOT has been widely reported by several recently studies, 6 , 7 with a focus on several genes and noncoding RNAs associated with cell differentiation. 8 , 9 …”

Experience with Tetralogy of Fallot Patients in a Tertiary Care Teaching Institute of North India

“…The presence of continuous flow with systolic prominence, in a vessel arising from the and LV length can be used to estimate the size of LV, LV end-diastolic volume is the preferred parameter for judging this. If LV end-diastolic volume is found to be less than 20 ml/sqm, it may be preferable to undergo a staged approach, 13 starting with a shunt, as was done in the case depicted in (Fig. 12 and Video 12).…”