Tetralogy of Fallot – ABC CARDIOL

IJCS

Case Report

Left Pulmonary Artery Aneurysm in an Adult Patient With Uncorrected Tetralogy of Fallot and Patent Ductus Arteriosus: A Case Report

Miguel Bernardino Antunes Vicente et al. Elsa Fernandes Roger Dopico Luis Mariano … Odete Mingas Domingos Ramos Lino Gonçalves

Abstract

The authors describe a case of an infrequent triple association: left pulmonary artery aneurysm (PAA), uncorrected tetralogy of Fallot (TOF) and patent ductus arteriosus (PDA), diagnosed in a 45-year-old adult patient during a check-up. The patient refused to undergo surgery and is currently being followed clinically.

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IJCS

Original Article

Predicting Factors of Surgical Mortality in Children and Adolescents Undergoing Correction of Tetralogy of Fallot

Patrícia de Souza Pinheiro et al. Vitor Manuel Pereira Azevedo Gabrielle Rocha

Abstract

Background

In tetralogy of Fallot, correction surgery is a priority choice, seeing that it is desirable to minimize pulmonary hypoflow and severe hypoxemia, which result in hypoxemic crises, with sudden worsening of cyanosis, tachypnea, and, in some cases, loss of consciousness, seizures, and even death.

Objective

To evaluate the predicting factors of surgical mortality in children and adolescents undergoing correction of tetralogy of Fallot.

Methods

Retrospective cross-sectional study carried out by consulting all surgical records of the Child and Adolescent Cardiology Service of the Brazilian National Institute of Cardiology, during the period from 2007 to 2010. Results with p values < 0.05 were considered significant.

Results

The study evaluated 93 medical records. In relation to the characteristics of the population at the time of surgery, the median age was 3.69 (2.13 to 5.79) years, and 58.06% (n = 54) were male. White was the most common skin color, accounting for 55.43% (n = 51) of cases. In relation to assessment of nutritional status, median weight was 13.25 (10.10 to 17.60) kg, and body mass index was 14.49 (13.44 to 16.28) kg/m2. Down syndrome was present in 11.83% (n = 11) of the patients. All patients underwent correction surgery (n = 93, 100%). Prior cyanotic crisis was found in 53.85% (n = 49) with p = 0.013; surgical procedure duration was 218.83 ± 60.63 minutes, with p = 0.003, and lactate was 1.88 ± 1.33 mg/dL during the immediate postoperative period, with p = 0.009. Regarding the outcome of surgical death, it was found in 15.05% (n = 14) of patients. Mean follow-up lasted 5.68 ± 3.76 years.

Conclusions

According to the factors analyzed, the duration of the surgical procedure, prior cyanotic crisis, and blood lactate level may be relevant to surgical mortality.

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ABC

Original Article

Right ventricular structure and function as possible determinants of surgical outcome 30 years after repair of tetralogy of Fallot

Sonia F. Mesquita et al. Raquel Snitcowsky Antonio Augusto Lopes

OBJECTIVE: To identify the variables that may be involved in the persistence of symptoms (functional class II, III, or IV vs. I) in patients being followed up for 30 years after surgical repair of tetralogy of Fallot. METHODS: Fifty-three patients (27 women), who underwent corrective surgery for tetralogy of Fallot between 1960 and 1970, were studied. Their ages ranged from 7 months to 26 years. At the end of follow-up, 13 patients were asymptomatic and the remaining were in functional class II (N=24), III (N=15), and IV (N=1). To differentiate asymptomatic from symptomatic patients, the following variables were analyzed: age at surgery, need for widening the pulmonary ring and trunk, need for a second (2nd OP) or 3rd operation, residual defect of the interventricular septum, residual regurgitation of the pulmonary valve, systolic gradient through the right ventricular outflow tract, right ventricular dilation or hypertrophy (RVH), cardiothoracic index (CTI), right and left ventricular ejection fraction (RVEF/LVEF), and arrhythmias. RESULTS: The univariate analysis showed an association between the presence of symptoms and the 2nd OP (P=0.03), an increase in the CTI (P=0.0001), moderate to severe RVH (P=0.002), and dilation (P=0.0003). In the logistic regression model, the combination of the 2nd OP (P=0.008), the RVH (P=0.002), and the reduction in RVEF (P=0.01) determined the presence of symptoms. CONCLUSION: Despite the surgical treatment, right ventricular remodeling and performance were the major determinants in the late follow-up of tetralogy of Fallot.

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Original Article

Right ventricular diastolic dysfunction in the postoperative period of tetralogy of Fallot

Silvia Meyer Cardoso et al. Nelson Itiro Miyague

OBJECTIVE: To assess right ventricular diastolic function in the intermediate postoperative period of repair of tetralogy of Fallot. METHODS: We carried out a case-control study with 60 patients divided into 2 groups as follows: 1) group I – 30 patients who had undergone repair of tetralogy of Fallot and 2) group II – 30 healthy children. The 2 groups were paired for age, sex, and body surface. The flows in the pulmonary and tricuspid valves were analyzed with Doppler echocardiography. The presence of anterograde flow at the end of diastole in the pulmonary artery defined restrictive right ventricular physiology. Surgical, radiological, electrocardiographic, and echocardiographic variables were analized in the group I. RESULTS: The velocity of the A wave and the E/A ratio for the tricuspid valve showed significant differences between the groups. Cases with E/A < 1.30 predominated in inspiration (group I – 19/30, and group II – 5/30). The duration of the QRS complex on the electrocardiogram was significantly increased in patients with E/A <1.30. Nineteen (63.3%) patients had restrictive right ventricular physiology, which had a longer postoperative period, longer duration of the QRS complex, and a lower E/A ratio in inspiration. The surgical and radiological variables showed no statistical difference. CONCLUSION: Restrictive right ventricular physiology was detected on the intermediate follow-up of most patients undergoing repair of tetralogy of Fallot. The postoperative period and QRS duration were increased in patients with impairment in diastolic function.

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Left Pulmonary Artery Aneurysm in an Adult Patient With Uncorrected Tetralogy of Fallot and Patent Ductus Arteriosus: A Case Report

Abstract

Predicting Factors of Surgical Mortality in Children and Adolescents Undergoing Correction of Tetralogy of Fallot

Abstract

Background

Objective

Methods

Results

Conclusions

Right ventricular structure and function as possible determinants of surgical outcome 30 years after repair of tetralogy of Fallot

Right ventricular diastolic dysfunction in the postoperative period of tetralogy of Fallot

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Formato de Documento Eletrônico (ABNT)

Formato de Documento Eletrônico (APA)

Formato de Documento Eletrônico (ISO)

Formato de Documento Eletrônico (Vancouver)

Formato de Documento Eletrônico (ABNT)

Formato de Documento Eletrônico (APA)

Formato de Documento Eletrônico (ISO)