초록접수 현황
| 17F-176 | 구연 발표 |
Short-term Outcomes after Total Correction with Pulmonary Valve and Right Ventricular Preservation in Tetralogy of Fallot Patients
Jae Gun Kwak, Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Purpose : Our hypothesis is that early exposure to free pulmonary regurgitation (PR) and right ventricle (RV) incision would be more harmful than residual pulmonary stenosis (PS) for the RV function in tetralogy of Fallot (TOF) patient.
Methods : From February 2016, we changed our surgical strategy for TOF as follows, regardless of the size of pulmonary annulus if the size of pulmonary arteries was tolerable for total correction; 1. Preserve the pulmonary valve (PV) function to minimize PR by extensive commissurotomy with annulus saving; 2. Preserve RV infundibular function by avoidance of RV incision. With this strategy, we performed total correction for 18 consecutive patients with TOF. We reviewed short-term clinical status and data of these patients.
Results : Preoperative patients’ mean age was 6.7±3.1 months (2.5~30.6 months), body weight was 8.0±0.7 kg (6.2~12.4 kg), body surface area was 0.38 ± 0.03 (0.32~0.55). The preoperative pressure gradient at right ventricular outflow tract and the z-score of PV were improved from 79.7±7.0 to 27.5±9.4 mmHg, and from -2.41±0.59 to -0.45±0.74 after operation during 8.3±1.5 months of follow-up. Only 1 case required re-intervention for residual PS. Sixteen patients showed trivial (4) or mild (12) degree of PR.
Conclusion : Short-term results were acceptable with our aggressively revised surgical strategy for total correction of TOF in the aspects of pulmonary function. Preserved PV showed tolerable function and tendency of growing in short-term follow up. We need mid- and long-term follow up for these patients’ RV function as well as function.
Methods : From February 2016, we changed our surgical strategy for TOF as follows, regardless of the size of pulmonary annulus if the size of pulmonary arteries was tolerable for total correction; 1. Preserve the pulmonary valve (PV) function to minimize PR by extensive commissurotomy with annulus saving; 2. Preserve RV infundibular function by avoidance of RV incision. With this strategy, we performed total correction for 18 consecutive patients with TOF. We reviewed short-term clinical status and data of these patients.
Results : Preoperative patients’ mean age was 6.7±3.1 months (2.5~30.6 months), body weight was 8.0±0.7 kg (6.2~12.4 kg), body surface area was 0.38 ± 0.03 (0.32~0.55). The preoperative pressure gradient at right ventricular outflow tract and the z-score of PV were improved from 79.7±7.0 to 27.5±9.4 mmHg, and from -2.41±0.59 to -0.45±0.74 after operation during 8.3±1.5 months of follow-up. Only 1 case required re-intervention for residual PS. Sixteen patients showed trivial (4) or mild (12) degree of PR.
Conclusion : Short-term results were acceptable with our aggressively revised surgical strategy for total correction of TOF in the aspects of pulmonary function. Preserved PV showed tolerable function and tendency of growing in short-term follow up. We need mid- and long-term follow up for these patients’ RV function as well as function.
첨부파일 : 2017추계.pptx
책임저자: Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
발표자: Jae Gun Kwak, E-mail : switch.surgeon@gmail.com