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.	李曉鋒, 范祥明, 李志強, 等. 肺血管發育不良性法洛四聯癥的分期治療. 心肺血管病雜志, 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.	劉治元, 張劍彬, 徐崇斐. 一期外科手術治療嬰兒期法洛四聯癥的近遠期效果觀察. 中國當代醫藥, 2016, 23(23): 19-21.
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6.	李軍朋, 李紅英, 董彥博, 等. 新型左心室擴大技術在左心室較小型嬰兒法洛四聯癥根治術中的應用. 中華實用兒科臨床雜志, 2014, 29(18): 1428-1431.
7.	許娜, 夏焙, 周蔚, 等. 兒童超聲心動圖測量指標正常參考值的建立及臨床意義. 中華醫學超聲雜志 (電子版), 2012, 9(1): 40-49.
8.	閆芳, 張會軍, 王軍, 等. 左心室較小的法洛四聯癥患兒一期矯治手術 38 例. 中國綜合臨床, 2014, 30(3): 310-313.
9.	崔存英, 張連仲, 劉琳, 等. 法洛四聯癥根治術后重癥監護室滯留危險因素研究. 中華實驗外科雜志, 2016, 33(2): 527-530.
10.	諶啟輝, 王平凡, 吳振宇, 等. 快速二期治療左心室發育差法洛四聯癥臨床體會. 醫藥論壇雜志, 2015, 36(10): 35-36.
11.	劉迎龍. 法洛四聯癥手術治療的進展. 心肺血管病雜志, 2014, 33(2): 147-149.
12.	楊志遠, 謝周良, 葛振偉, 等. 左心室發育不良法洛四聯癥的手術矯治. 山東醫藥, 2010, 50(34): 66-67.
13.	王霖, 陳勝喜, 羅凡硯, 等. 小左室法洛四聯治療探索. 中國現代醫學雜志. 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.	呂瑛, 劉召明, 王軍, 等. 嬰幼兒法洛四聯癥 109 例的外科治療. 河北醫科大學學報, 2016, 37(2): 196-198.
16.	陳明寶, 莫緒明, 戚玉東, 等. 8 公斤以下嬰兒法洛四聯癥根治圍術期治療及并發癥分析. 中國心血管病研究, 2016, 14(2): 164-166.
17.	劉文巧, 李世革, 陳順英, 等. 32 例法洛四聯癥術后并發癥如低心排血綜合癥等監護策略探討. 心血管病防治知識 (學術版), 2014, (10): 108-109.
18.	王風. 腹膜透析在小兒先天性心臟病術后低心排的應用. 中國臨床新醫學, 2014, 7(2): 157-159.

1. 李曉鋒, 范祥明, 李志強, 等. 肺血管發育不良性法洛四聯癥的分期治療. 心肺血管病雜志, 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. 劉治元, 張劍彬, 徐崇斐. 一期外科手術治療嬰兒期法洛四聯癥的近遠期效果觀察. 中國當代醫藥, 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. 李軍朋, 李紅英, 董彥博, 等. 新型左心室擴大技術在左心室較小型嬰兒法洛四聯癥根治術中的應用. 中華實用兒科臨床雜志, 2014, 29(18): 1428-1431.
7. 許娜, 夏焙, 周蔚, 等. 兒童超聲心動圖測量指標正常參考值的建立及臨床意義. 中華醫學超聲雜志 (電子版), 2012, 9(1): 40-49.
8. 閆芳, 張會軍, 王軍, 等. 左心室較小的法洛四聯癥患兒一期矯治手術 38 例. 中國綜合臨床, 2014, 30(3): 310-313.
9. 崔存英, 張連仲, 劉琳, 等. 法洛四聯癥根治術后重癥監護室滯留危險因素研究. 中華實驗外科雜志, 2016, 33(2): 527-530.
10. 諶啟輝, 王平凡, 吳振宇, 等. 快速二期治療左心室發育差法洛四聯癥臨床體會. 醫藥論壇雜志, 2015, 36(10): 35-36.
11. 劉迎龍. 法洛四聯癥手術治療的進展. 心肺血管病雜志, 2014, 33(2): 147-149.
12. 楊志遠, 謝周良, 葛振偉, 等. 左心室發育不良法洛四聯癥的手術矯治. 山東醫藥, 2010, 50(34): 66-67.
13. 王霖, 陳勝喜, 羅凡硯, 等. 小左室法洛四聯治療探索. 中國現代醫學雜志. 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. 呂瑛, 劉召明, 王軍, 等. 嬰幼兒法洛四聯癥 109 例的外科治療. 河北醫科大學學報, 2016, 37(2): 196-198.
16. 陳明寶, 莫緒明, 戚玉東, 等. 8 公斤以下嬰兒法洛四聯癥根治圍術期治療及并發癥分析. 中國心血管病研究, 2016, 14(2): 164-166.
17. 劉文巧, 李世革, 陳順英, 等. 32 例法洛四聯癥術后并發癥如低心排血綜合癥等監護策略探討. 心血管病防治知識 (學術版), 2014, (10): 108-109.
18. 王風. 腹膜透析在小兒先天性心臟病術后低心排的應用. 中國臨床新醫學, 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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