Clinical effect comparison of three operations for one-stage radical correction of small left ventricle in children with tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Junpeng ^1,2 , DONG Yanbo ¹ , ZHANG Huijun ¹ , SU Zhenyu ¹ , LI Hongying ¹ , ZHANG Man ¹ , LIU Yan ¹ , WANG Jun ¹ ,  HUANG Jiancheng ¹

1. Department of Cardiac Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, P.R.China;
2. Zibo Integrated TCM & Western Medicine Hospital, Zibo, 255026, Shandong, P.R.China;

Corresponding author：

HUANG Jiancheng, Email: 1471717784@qq.com

Keywords：

Tetralogy of Fallot; small left ventricle; enlargement of left ventricle; one-stage radical operation

DOI：

10.7507/1007-4848.201706021

Video：

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Objective To compare the clinical effect of three operations for one-stage radical correction of small left ventricle in children with tetralogy of Fallot (TOF). Methods We retrospectively analyzed the clinical data of 120 patients with left ventricular dysplasia and TOF undergoing one-stage radical surgery in the First Hospital of Hebei Medical University from December 2004 to May 2017. According to the different types of operation used, they were divided into 3 groups, including a routine group (30 patients, 16 males and 14 females, aged 11.58±2.05 months ranging from 3-24 months), a large patch group (40 patients, 22 males, 18 females, aged 11.22±2.24 months ranging from 3-25 months) who were treated with a large patch, and an enlarged ventricular septal defect group (50 patients, 26 males, 24 females, aged 10.17±2.15 months ranging from 3-22 months) using new left ventricular enlargement technique to enlarge ventricular septal defect. The clinical effect of the three operations were compared. Results The incidence of postoperative low cardiac output syndrome (6.0% vs. 40.0%vs. 50.0%, P<0.05), renal failure (4.0%vs. 37.5% vs.46.7%, P<0.05), infection rate (10.0%vs. 50.0% vs.66.7%, P<0.05), mortality (2.0%vs. 12.5% vs. 20.0%, P<0.05), ventilator-assisted time (8.34±5.24 hvs. 36.14±10.91 h vs. 38.58±10.12 h, P<0.05), ICU stay (4.13±1.01 dvs. 7.64±2.11 d vs.8.03±3.03 d, P<0.05), hospital stay (10.48±4.26 dvs. 21.02±3.23 d vs. 22.52±2.93 d, P<0.05) and hospitalization costs (51 300±9 400 yuanvs.103 200±39 300 yuan vs. 115 500±35 200 yuan, P<0.05) were less in the enlarged ventricular septal defect group compared with the other two groups. Conclusion The clinical effect of enlarged ventricular septal defect is better than that of the routine and large patch methods, and long-term efficacy should be further followed up.

Citation： LI Junpeng, DONG Yanbo, ZHANG Huijun, SU Zhenyu, LI Hongying, ZHANG Man, LIU Yan, WANG Jun, HUANG Jiancheng. Clinical effect comparison of three operations for one-stage radical correction of small left ventricle in children with tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(7): 587-592. doi: 10.7507/1007-4848.201706021 Copy

1.	李晓锋, 范祥明, 李志强, 等. 肺血管发育不良性法洛四联症的分期治疗. 心肺血管病杂志, 2014, 33(5): 716-718.
2.	Lee CH, Kwak JG, Lee C. Primary repair of symptomatic neonates with tetralogy of Fallot with or without pulmonary atresia. Korean J Pediatr, 2014, 57(1): 19-25.
3.	Egbe AC, Mittnacht AJ, Nguyen K, et al. Risk factors for morbidity in infants undergoing tetralogy of fallot repair. Ann Pediatr Cardiol, 2014, 7(1): 13-18.
4.	刘治元, 张剑彬, 徐崇斐. 一期外科手术治疗婴儿期法洛四联症的近远期效果观察. 中国当代医药, 2016, 23(23): 19-21.
5.	Kouchoukos NT, Blackstone EH, Doty DB, et al. Kirklin/Barrat-Boyes cardiac surgery, 3rd editon. London: Churchill Livingstone, 2003. 961.
6.	李军朋, 李红英, 董彦博, 等. 新型左心室扩大技术在左心室较小型婴儿法洛四联症根治术中的应用. 中华实用儿科临床杂志, 2014, 29(18): 1428-1431.
7.	许娜, 夏焙, 周蔚, 等. 儿童超声心动图测量指标正常参考值的建立及临床意义. 中华医学超声杂志 (电子版), 2012, 9(1): 40-49.
8.	闫芳, 张会军, 王军, 等. 左心室较小的法洛四联症患儿一期矫治手术 38 例. 中国综合临床, 2014, 30(3): 310-313.
9.	崔存英, 张连仲, 刘琳, 等. 法洛四联症根治术后重症监护室滞留危险因素研究. 中华实验外科杂志, 2016, 33(2): 527-530.
10.	谌启辉, 王平凡, 吴振宇, 等. 快速二期治疗左心室发育差法洛四联症临床体会. 医药论坛杂志, 2015, 36(10): 35-36.
11.	刘迎龙. 法洛四联症手术治疗的进展. 心肺血管病杂志, 2014, 33(2): 147-149.
12.	杨志远, 谢周良, 葛振伟, 等. 左心室发育不良法洛四联症的手术矫治. 山东医药, 2010, 50(34): 66-67.
13.	王霖, 陈胜喜, 罗凡砚, 等. 小左室法洛四联治疗探索. 中国现代医学杂志. 2010, 20(1): 87-92.
14.	Bigdelian H, Sedighi M. Repair of tetralogy of Fallot in infancy via the atrioventricular approach. Korean J Thorac Cardiovasc Surg, 2016, 49(1): 9-14.
15.	吕瑛, 刘召明, 王军, 等. 婴幼儿法洛四联症 109 例的外科治疗. 河北医科大学学报, 2016, 37(2): 196-198.
16.	陈明宝, 莫绪明, 戚玉东, 等. 8 公斤以下婴儿法洛四联症根治围术期治疗及并发症分析. 中国心血管病研究, 2016, 14(2): 164-166.
17.	刘文巧, 李世革, 陈顺英, 等. 32 例法洛四联症术后并发症如低心排血综合症等监护策略探讨. 心血管病防治知识 (学术版), 2014, (10): 108-109.
18.	王风. 腹膜透析在小儿先天性心脏病术后低心排的应用. 中国临床新医学, 2014, 7(2): 157-159.

1. 李晓锋, 范祥明, 李志强, 等. 肺血管发育不良性法洛四联症的分期治疗. 心肺血管病杂志, 2014, 33(5): 716-718.
2. Lee CH, Kwak JG, Lee C. Primary repair of symptomatic neonates with tetralogy of Fallot with or without pulmonary atresia. Korean J Pediatr, 2014, 57(1): 19-25.
3. Egbe AC, Mittnacht AJ, Nguyen K, et al. Risk factors for morbidity in infants undergoing tetralogy of fallot repair. Ann Pediatr Cardiol, 2014, 7(1): 13-18.
4. 刘治元, 张剑彬, 徐崇斐. 一期外科手术治疗婴儿期法洛四联症的近远期效果观察. 中国当代医药, 2016, 23(23): 19-21.
5. Kouchoukos NT, Blackstone EH, Doty DB, et al. Kirklin/Barrat-Boyes cardiac surgery, 3rd editon. London: Churchill Livingstone, 2003. 961.
6. 李军朋, 李红英, 董彦博, 等. 新型左心室扩大技术在左心室较小型婴儿法洛四联症根治术中的应用. 中华实用儿科临床杂志, 2014, 29(18): 1428-1431.
7. 许娜, 夏焙, 周蔚, 等. 儿童超声心动图测量指标正常参考值的建立及临床意义. 中华医学超声杂志 (电子版), 2012, 9(1): 40-49.
8. 闫芳, 张会军, 王军, 等. 左心室较小的法洛四联症患儿一期矫治手术 38 例. 中国综合临床, 2014, 30(3): 310-313.
9. 崔存英, 张连仲, 刘琳, 等. 法洛四联症根治术后重症监护室滞留危险因素研究. 中华实验外科杂志, 2016, 33(2): 527-530.
10. 谌启辉, 王平凡, 吴振宇, 等. 快速二期治疗左心室发育差法洛四联症临床体会. 医药论坛杂志, 2015, 36(10): 35-36.
11. 刘迎龙. 法洛四联症手术治疗的进展. 心肺血管病杂志, 2014, 33(2): 147-149.
12. 杨志远, 谢周良, 葛振伟, 等. 左心室发育不良法洛四联症的手术矫治. 山东医药, 2010, 50(34): 66-67.
13. 王霖, 陈胜喜, 罗凡砚, 等. 小左室法洛四联治疗探索. 中国现代医学杂志. 2010, 20(1): 87-92.
14. Bigdelian H, Sedighi M. Repair of tetralogy of Fallot in infancy via the atrioventricular approach. Korean J Thorac Cardiovasc Surg, 2016, 49(1): 9-14.
15. 吕瑛, 刘召明, 王军, 等. 婴幼儿法洛四联症 109 例的外科治疗. 河北医科大学学报, 2016, 37(2): 196-198.
16. 陈明宝, 莫绪明, 戚玉东, 等. 8 公斤以下婴儿法洛四联症根治围术期治疗及并发症分析. 中国心血管病研究, 2016, 14(2): 164-166.
17. 刘文巧, 李世革, 陈顺英, 等. 32 例法洛四联症术后并发症如低心排血综合症等监护策略探讨. 心血管病防治知识 (学术版), 2014, (10): 108-109.
18. 王风. 腹膜透析在小儿先天性心脏病术后低心排的应用. 中国临床新医学, 2014, 7(2): 157-159.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effect comparison of three operations for one-stage radical correction of small left ventricle in children with tetralogy of Fallot

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