|
Objective: To summarize the method of surgical treatment of tetralogy of Fallot and its efficacy. : 2008-03 to 2010-01 have seen 22 cases of tetralogy of Fallot patients. Are as follows: 12 males and 10 females. Age from 9 months to 29 years old, the average age (4.67 ± 6.83) years; weight to 49kg, the average weight of (12.78 ± 10.31) kg. In addition to individual patients is not associated with clubbing, resting the rest of the patients had cyanosis and clubbing. ECG showed right ventricular hypertrophy. The chest X-ray showed the heart shadow mostly shoe, cardiothoracic ratio from 0.44 to 0.63, have decreased pulmonary blood. Peripheral oxygen saturation of 64.6 to 97.6%, the average peripheral oxygen saturation (83.09 ± 10.60)%; hemoglobin 89 to 205 g / L average hemoglobin (146.00 ± 38.91) g / L. At low cardiopulmonary bypass radical surgery of tetralogy of Fallot. Right ventricular outflow tract widening in 8 cases (36.37%), right ventricular outflow tract to the pulmonary artery cross-valve ring widening in 14 cases (63.63%). Results: The group was complications in 4 cases (18.18%), and 1 patient died (4.55%). Low cardiac output syndrome in 2 cases, intravenous infusion of dopamine, milrinone, dobutamine, make up the volume, based on the value of plasma colloid osmotic pressure, hemoglobin and hematocrit results of whole blood or plasma strengthen the diuretic and other symptomatic treatment, 2 patients were cured. Respiratory failure in 1 case, the control lung infections, ventilator-assisted breathing and body support improved after treatment. 1 patient one day renal failure, given peritoneal dialysis, after 2 days of multiple organ failure, low cardiac output, oxygen partial pressure and oxygen saturation decreased rapidly, heart rate, respiratory arrest, rescue invalid deaths. The whole group after review found no the interventricular septum residual leakage. Routine use of dopamine 2.5 to 10 ug / (kg · min), average (3.77 ± 2.29) days; Milrinone of 0.25 to 0.5ug / (Kg · min), average (2.80 ± 2.91) days; ventilation time average (1.7 ± 1.1) days. The mean postoperative hospital stay (13.17 ± 5.04) days. Conclusion: Tetralogy of Fallot is the most common cyanotic congenital heart disease, surgery is the only option. Pathophysiological characteristics of tetralogy of Fallot tissue hypoxia, baby surgery conducive to the protection of the right ventricular function, and promote the growth and development of pulmonary especially around the pulmonary vascular to reduce chronic hypoxemia on the heart, liver and kidney and nervous system damage, avoid and reduce Preoperatively, hypoxia attack late postoperative ventricular arrhythmias and cause sudden death. Tetralogy of Fallot surgery mortality rate is higher in early childhood surgery, the majority can choose a surgery and get satisfactory results. The two surgery should be considered for pulmonary poorly developed. Early for a radical mastectomy to prevent chronic hypoxia potential damage to vital organs such as the heart, brain, lung, kidney, prevent secondary pulmonary collateral formation. Severe hypoplasia of pulmonary artery distal first palliative surgery to relieve hypoxia, and then phased surgery. Group, 3 patients less than 1 year old infant tetralogy of Fallot radical mastectomy, the youngest only nine months. Satisfactory surgical correction is the key to successful operation. The most common postoperative complications included low cardiac output syndrome, multiple organ failure, pulmonary perfusion, bleeding, cardiac arrhythmias.
|