Early results after total correction of tetralogy of Fallot (TOF) in Mosul Center of Cardiology and Cardiac Surgery
Abstract
Objectives: Report an early follow-up in patients after TOF repair and special concern to Transatrial approach to find important predictors of adverse results.
Methods: An original article (retrospective study) of 39 cases (26 male and 13 female) referred from different hospitals to our department for surgical management from (June 2012 till June 2016) including all cases of pediatric & adult age group that undergoing Total correction of TOF in Mosul Center of Cardiology and Cardiac Surgery (MCCCS). Weight distributions ranged from (14 – 80) kg and the mean body weight was (35.68 kg). Body surface area ranged from 0.47 to 1.92 with a mean of 1.16 and median 1.26. Age ranged from (3.5 - 34) years (median of 12y). Diagnosis of patients done by simple echocardiography study of the heart, cardiac catheterization with other investigations. We include all approaches of repair like Transatrial and Transventricular and patients with small pulmonary arteries need additional pulmonary annuloplasty or arterioplasty enlarge pulmonary arteries. The associated anomalies were 25 patients (46.1%).
Results: In this study, there was 3 case death (7.6%), the mean aortic clamp time 74.8 ranged from 33 - 120 mins and while the mean cardiopulmonary bypass time was 130 minutes, ranged from 75 - 170 minutes. The mean perfusion time was 101.1 min ranged from (77-172) mins, time needed for weaning off from the ventilation ranged from 5.45 to 10 hours. In 71.8% (28 cases) inotropic support drugs was required for coming off bypass or during ICU stay, while 28.2 % (11 cases) no inotropes were needed. All patients remained in normal sinus rhythm. In 11 cases (28.2%) developed cardiac arrhythmias, 5 cases temporary supraventricular arrhythmias and 4 cases RBBB occurred postoperatively, and 2 cases have complete heart block, from all 11 patient 7 cases only required temporary pacing, the other 4 cases resolved with medical therapy and no patient developed persist cardiac arrhythmias. 4 case only developed pericardial effusion that didn’t require any intervention and managed conservatively. 2 cases developed Pneumothorax and managed by simple thoracostomy tube. No respiratory failure, one case developed acute renal failure and died later.one patient failed to weaned from CBP machine and died later. (The preoperative RVOT pressure gradient ranged from 48 – 160 mmHg, mean 93.97 mmHg. The gradient was at early post-operative follow up echocardiography 38.7 mmHg then it decreased on late follow-up to mean 25.7 mmHg in TA/TP approach.
Conclusion: Surgical management of TOF in Mosul cardiac center is feasible technique by Transatrial approach is associated with excellent early results following surgery in spite of mortality rate.
