Fallot Tetralojisi Tanısı ile Takip Edilen Hastaların Kısa ve Orta Dönem Sonuçlarının Değerlendirilmesi. Evaluation of Short- and Intermediate-Term Outcomes of Children with Tetralogy of Fallot

Yıl 2020, Cilt: 11 Sayı: 3, 353 - 357, 21.09.2020

Mahmut Keskin

Öz

Amaç: Fallot tetralojisi tanısı alan çocuklarda, belirli bulguların varlığında, düzeltme ameliyatları yapılmaktadır. Bu çalışmada Fallot tetralojisi tanılı hastalarımızda uygulanan cerrahi tedaviler ile olguların kısa ve orta dönem sonuçlarını geriye dönük olarak değerlendirmeyi amaçladık.
Materyal-Metot: Çalışmaya Ağustos 2017- Haziran 2020 tarihleri arasında hastanemizin pediatrik kardiyoloji bölümünce izlenen Fallot tetralojisi tanılı hastalar dahil edildi. Olgulara uygulanan cerrahi işlemler ile ameliyat öncesi ve sonrası izlemlerdeki veriler, hasta dosyaları incelenerek kaydedildi
Bulgular: Çalışmaya alınan 27 hastadan 16’sı erkek, 11’i kız idi. McGoon oranı, Nakata indeksi ve pulmoner arter z-skoru, ameliyat edilme şartlarını karşılayan 19 hastaya cerrahi uygulanmıştı. Tek operasyon geçiren hasta sayısı 13 iken, iki operasyon geçiren hasta sayısı 6 idi. İlk operasyonda 14 hastaya (ortanca yaş: 10 ay) tam düzeltme operasyonu uygulanmıştı. İlk ameliyattan sonra izlem süreleri 1-143 ay arasında değişmekteydi. Tam düzeltme ameliyatından sonra 2 hastaya (91 aylık ve 148 aylık iken) pulmoner kapak replasmanı yapılmıştı. Hastaların hiçbirinde ciddi aritmi gelişmediği kaydedildi.
Sonuç: Çalışmamızın bulguları, bir yaş altı Fallot tetralojisi tanılı çocuklarda, McGoon oranı, Nakata indeksi ve pulmoner arter z-skoru değerlendirilerek tam düzeltme ameliyatı yapılmasının olumlu sonuçlar ile ilişkili olduğunu düşündürmektedir.


ABSTRACT

Objective: In children with tetralogy of Fallot (TOF), correction surgery may be performed in the presence of certain findings. We aimed to evaluate the surgical procedures and short- and intermediate-term outcomes of our patients with TOF retrospectively.
Material-Method: This study included patients with the diagnosis of TOF who were followed-up in the pediatric cardiology unit of our hospital between August 2017 and June 2020. Surgical procedures performed and data at pre- and postoperative follow-up were noted from the patients’ records.
Results: Among the 27 cases with the diagnosis of TOF, 16 were male and 11 were female. Nineteen patients who fulfilled the required levels of McGoon ratio, Nakata index and pulmonary artery z-score underwent at least one operation. Among them, 13 were operated once, whereas 6 were operated twice. In 14 patients, complete repair was undertaken at the first surgery (median age: 10 months). Postoperative follow-up duration ranged between 1 and 143 months. In 2 patients, pulmonary valve replacement was carried out after complete repair (at the ages of 91 months and 148 months). None of the patients developed severe arrhythmia.
Conclusions: The results of this study suggest that in infants with TOF, complete repair by assessing the McGoon ratio, Nakata index and pulmonary artery z-score may be associated with favourable short- and intermediate-term outcomes.

Anahtar Kelimeler

Fallot tetralojisi,, İzlem,, Cerrahi, Sonuç., Tetralogy of Fallot, Follow-up, Outcome., Surgery

Kaynakça

• 1. Zuberbuhler JR: Tetralogy of Fallot Adams FH, Emmanouilides GC, riemenschneider TA (eds): Moss Heaıt Disease in Infants, Children, and Adolescents. Baltimore, Williams and Wilkins Co, Volume 2, 1989, pp 273-288.
• 2. Erk MK, Yüksel M, Baysal MK, Kolbakır F. Tam düzeltimi yapılan 26 Fallot tetralojili olgunun ameliyat öncesi ve sonrası değerlendirmesi. T Klin Kardiyoloji 1992;5:156-160.
• 3. Özkutlu S, Saraçlar M, Özme Ş, Yurdakul Y. Echocardiographic left ventricular size in the selection of surgical treatment in patients with tetralogy of Fallot. Turkish J Pediatr 1987;29:187-197.
• 4. Shimazaki Y, Maehara T, Blacstone EH, Kirklin JW, Bargeron Jr LM. The structure of the pulmonary circulation in tetralogy of Fallot with pulmonary atresia. J Thorac Cardiovasc Surg 1988;95:1048-1058.
• 5. Nakata S, Ihai Y, Takanashi Y, Kurosawa H, Tezuka K, Nakazawa M, et al. A new method for the quantitative standardization of cross-sectional area of the pulmonary arterios in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984;88:610-619.
• 6. Kirklin JW, Blackstone EH, Kirklin JK, Pacifico AD. Precting the degree of relief of the pulmonary stenosis or atresia after the repair of tetralogy of Fallot. Sem Thorac Cardiovasc Surg 1990;2:55-60.
• 7. Hernefter PJ, Zahra KG, Rowe SAT, Manolio TA, Gott VL, Reitz BA, et al. Long term results of total repair of tetralogy of Fallot in childhood. Ann Thorac Surg 1980;50:179-185.
• 8. Natio Y, Fujita T, Manabe H, Kawashima Y The criteria for reconstruction of right ventricular outflow tract in total correction of tetralogy of Fallot. J Thorac Cardiovasc Surg 1980;80:574-581.
• 9. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurements. Circulation 1978;58:1072-1083.
• 10. Sanchez HE, Cornish EM, Feng CS, Nobrega J, Hassoulas MJ, NettoM, et al. The surgical treatment of tetralogy of Fallot. Ann Thorac Surg 1984;7:431-436.
• 11. Kirklin JW, Blackstone EH, Pacifico AD, Kirklin JK, Bargeron Jr LM. Risk factors for early and late failure after repair of tetralogy of fallot, and their neutralization. Thorac Cardiovasc Surg 1984;32:208-214.
• 12. Hammon Jr JW, Henry Jr CL, Merrill WH, Graham Jr TP, Bender Jr HW. Tetralogy of Fallot: Selective surgical management can minimize operative mortality. Ann Thorac Surg 1985;40:280-284.
• 13. Lee C, Lee CN, Kim SC, Lim C, Chang YH, Kang CH, et al. Outcome after one-stage repair of tetralogy of Fallot. J Cardiovasc Surg (Torino) 2006;47:65-70.
• 14. Van Arsdell GS, Maharaj GS, Tom J, Rao VK, Coles JG, Freedom RM, et al. What is the optimal age for repair of tetralogy of Fallot? Circulation 2000;102:23-29.
• 15. Caspi J, Zalstein E, Zucker N, Applebaum A, Harrison LH Jr, Munfakh NA, et al. Surgical management of tetralogy of Fallot in the first year of life. Ann Thorac Surg 1999;68:1344-1348. 16. Poirier RA, Mc Goon DC, Daniclson GK , Wallace RB, Ritter DG, Moodie DS et al. Late results after repair of tetralogy of Fallot. J Thorac Cardiovase Surg 1977;73:900-908.
• 17. Şaşmazel A, Baysal A, Yıldırım A, Fedakar A, Onursal B, Büyükbayrak F, et al. Our short and mid-term results of primary repair in infants less than one year of age with tetralogy of Fallot. Turkish Journal of Thoracic and Cardiovascular Surgery. 2011;19:19-23.
• 18. Erdoğan HB, Bozbuğa N, Kayalar N, Erentuğ V, Omeroğlu SN, Kirali K, et al. Long-term outcome after total correction of Tetralogy of Fallot in adolescent and adult age. J Card Surg. 2005;20:119- 123.
• 19. Çobanoğlu A and Schultz JM. Total correction of tetralogy of Fallot in the first year of life: late results. Ann ThoracSurg. 2002;74:133-138.
• 20. Kouchoukos NT, Blackstone EH, Doty DB. Ventricular septal defect with pulmonary stenosis or atresia.In Kirklin/ Barratt-Boyes (eds) Cardiac Surgery, 3rd edn. Churchhill Livingstone, Philadelphia. 2003;946-1073.
• 21. Özdemir R, Öner T , Demirpençe S , Karadeniz C , Yılmazer MM , Doksöz Ö , et al. Factors affecting pulmonary artery development indices prior to total correction surgery in cases with Tetralogy of Fallot: An observational retrospective review of 100 cases. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi 2015; 5:120-124.