Postoperatif Fallot Tetralojili Çocuklarda Kısa ve Orta Dönem Sonuçlarımızın Değerlendirilmesi

Yıl 2021, Cilt: 15 Sayı: 4, 280 - 286, 16.07.2021

Erhan Aygün Aygün Dindar Kemal Nişli Rukiye Ömeroğlu

https://doi.org/10.12956/tchd.694094

Öz

Amaç: Tam düzeltme ameliyatı yapılmış Fallot tetralojili hastalarımızın klinik durumlarının değerlendirilmesi, ritim bozukluklarının araştırılması, ekokardiyografi ile ventrikül fonksiyonlarının ve aort kökü dilatasyonunun değerlendirilmesidir.

Gereç ve Yöntemler: İstanbul Üniversitesi, İstanbul Tıp Fakültesi Çocuk Kardiyoloji bölümünde izlenen, düzeltme operasyonu uygulanmış Fallot tetralojili 50 çocuk çalışmaya dahil edildi. Düzeltilmiş Fallot tetralojili olgular aort kökü dilate olanlar ve dilate olmayanlar diye iki guruba ayrıldı. Her iki gurup arasında cinsiyet, tam düzeltme operasyonu yaşı, aort yetersizliği, triküspit yetersizliği, pulmoner yetersizlik, palyatif tedavi ve transanüler yama kullanımı açısından farklar değerlendirildi. Pulmoner kapak yetmezliği, tam düzeltme ameliyatı sırasında uygulanan transanüler yama yapılanlar ve yapılmayanlar olarak karşılaştırıldı.
Düzeltilmiş Fallot tetralojili olguların ekokardiyografik olarak ölçülen aort kökü ve asendan aort çapları yaş, cinsiyet ve vücut yüzey alanlarına göre normal dağılımları ile değerlendirildi.

Bulgular: Çalışmaya 24 Ocak-15 Mayıs 2014 tarihleri arasında 50 olgu alındı. Çalışmaya katılan olguların yaşları 2-21 yıl arasında değişmekte olup, ortalama 9.9 ±4.5 yıldır. Çalışmaya katılanların %52’si (n=26) erkek, %48’i (n=24) kızdır. Olguların total düzeltme yaşları 6 (0.5 yıl) ile 190 (15.8 yıl) ay arasında değişmekte olup, ortalama 28.3 ± 28.3 (2.3 ± 2.3 yıl) aydır. Postoperatif süreleri 1.3-17.8 yıl arasında değişmekte olup, ortalama 8.0 ± 4.1 yıldır. Olguların %28’ine (n=14) palyatif tedavi uygulanmıştır. Olguların aort kök ölçümleri 18.0 ile 42.5 mm arasında değişmekte olup, ortalama 27.9 ±5.3 mm’dir. Olguların %12’sinin (n=6) aort kökü dilatasyonu yok iken, %88’inin (n=44) aort kökü dilatasyonu vardır. Olguların tamamında (%100) sağ ventrikül dilatasyonu ve asendan aort dilatasyonu vardır.
Transanüler yama uygulananlarda, orta ve ağır pulmoner yetmezlik daha az saptandı (p: 0.02).
Sonuç: Olguların %88’inde (n: 44) aort kökü dilatasyonu saptandı. Yıllık aort kökü çapı ölçümlerinin verilmesi, Fallot tetralojili hastalarda ilerleyici aort kökü dilatasyonunun tedavisinde daha etkili bir stratejisinin planlanmasına yardımcı olacaktır.

Anahtar Kelimeler

Fallot Tetralojisi, Aort Kökü Dilatasyonu, Tam düzeltme ameliyatı

Evaluation of Short and Mid-term Outcomes in Children with Postoperative Fallot Tetralogy

Öz

Objective: This study aims to evaluate clinic situations, investigate arrhythmias, and assess ventricle function by echocardiography and aortic root dilation of patients with Tetralogy of Fallot who had undergone total correction surgery.

Material and Methods: 50 children with Tetralogy of Fallot and who had undergone a total correction operation in I.U. Faculty of Medicine Pediatric Cardiology Department were included to study. Corrected Tetralogy of Fallot cases were divided into two main groups as “aortic root dilated group” and “aortic root not-dilated group”. Groups were evaluated as to their gender, age of correction surgery, presence of aortic failure, tricuspid failure, pulmonary failure, aorta pulmonary shunt treatment and usage of transannular patch. Pulmonary valve failure was compared as those with and without transannular patches applied during the total correction surgery. Echocardiographically measured aortic root and ascending aorta diameters were assessed according to age, gender, and body surface area of the corrected Fallot Tetralogy cases.

Results: 50 subjects were involved to study in date between 24th Jan. 2014 and 15th May 2014. Age of the cases in study varied between 2 and 21 years and average age was 9.9 ± 4.5 years. 52% (n=26) of them are male and 48% are female (n=24). Total correction age was varied between 6 months (0.5 years) and 190 months (15.8 years) and average age was 28.3±28.3 months (2.3 ±2.3 years). Their postoperative periods were varied between 1.3 and 17.8 years and average period was 8.0±4.1 years. 28% (n=14) of the cases were received palliative treatment. Aortic root size was varied between 18 and 42.5 and average size was measured as 27.9±5.3 mm. Aortic root dilation ratio of the cases was 88% (n=44) while 12% of cases (n=6) had no aort root dilatation. All patients had right ventricle and ascending aorta dilation. Moderate and severe pulmonary failure was found less in those who underwent transannular patch.

Conclusion: Aortic root dilation was detected in 88% (n=44) of the cases. Providing annual aortic root diameter measurements will help to plan a more effective strategy for the treatment of progressive aortic root dilatation in patients with Fallot tetralogy.

Anahtar Kelimeler

Tetralogy of Fallot, Total Correction Operation, Aortic Root Dilatation

Kaynakça

• 1. Karl TR, Alphonso N. Tetralogy of fallot. Operative Cardiac Surgery: CRC Press; 2018. p. 558-71.
• 2. Niwa K, Siu SC, Webb GD, Gatzoulis MA. Progressive aortic root dilatation in adults late after repair of tetralogy of Fallot. Circulation. 2002;106(11):1374-8.
• 3. Bonello B, Shore DF, Uebing A, Diller G-P, Keegan J, Burman ED, et al. Aortic dilatation in repaired tetralogy of Fallot. JACC Cardiovasc Imaging. 2018;11(1):150-2.
• 4. van der Ven JP, Van den Bosch E, Bogers AJ, Helbing WA. Current outcomes and treatment of tetralogy of Fallot. F1000Research. 2019;8.
• 5. Shinebourne EA, Anderson RH. Fallot’s tetralogy. In: Paediatric cardiology. Anderson RH, Baker EJ, Macartney FJ, Rigby ML, Shinebourne EA, Tynan M, eds. 2nd edn. Toronto: Churchill Livingstone, London; 2002: 1213–502.
• 6. Tretter JT, Morello M, Chaudhry A, Veldtman GR. The management of tetralogy of Fallot after corrective surgery. SA Heart. 2018;15(1):6-15.
• 7. Semizel E, Öztürk B, Bostan OM, Cil E, Ediz B. The effect of age and gender on the electrocardiogram in children. Cardiol Young. 2008;18(1):26-40.
• 8. Kaiser T, Kellenberger CJ, Albisetti M, Bergsträsser E, Buechel ERV. Normal values for aortic diameters in children and adolescents – assessment in vivo by contrast-enhanced CMR-angiography. Journal of Cardiovascular Magnetic Resonance 2008, 10:56
• 9. Mestre M, Reychler G, Goubau C, Moniotte S. Correlation between cardiopulmonary exercise test, spirometry, and congenital heart disease severity in pediatric population. Pediatr Cardiology. 2019;40:871–877. 
• 10. Gök RN. Evaluation of operated tetralogy of fallot patients at midterm with 24-hour rhythm monitoring (holter) and cardi̇opulmonary exercise testing. Dissertation, Marmara Unv. Istanbul 2016, sf 17-31. 
• 11 Chong W-Y, Wong WH, Chiu CS, Cheung Y-F. Aortic root dilation and aortic elastic properties in children after repair of tetralogy of Fallot. The American journal of cardiology. 2006;97(6):905-9.
• 12 Chugh R. Echocardiographic characterization of the aortic root in adults with tetralogy of Fallot. Circulation. 2001;104:II-558.
• 13 Grotenhuis HB, Dallaire F, Verpalen IM, van den Akker MJ, Mertens L, Friedberg MK. Aortic Root Dilatation and Aortic-Related Complications in Children After Tetralogy of Fallot Repair. Circ Cardiovasc Imaging. 2018;11(12):e007611.
• 14. Arafat A, Elatafy E, Elshedoudy S, Zalat M, Abdallah N, Elmahrouk A. Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair. J Cardiothorac Surg. 2018;13:1-14.
• 15. Ordovas KG, Keedy A, Naeger DM, Kallianos K, Foster E, Liu J, et al. Dilatation of the ascending aorta is associated with presence of aortic regurgitation in patients after repair of tetralogy of Fallot. The international journal of cardiovascular imaging. 2016;32(8):1265-72.
• 16. Watanabe T, Ueno T, Kanaya T, Okuda N, Araki K, Tominaga Y, et al. Analysis of Risk Factors for Progression of Aortic Regurgitation in Adults Late After Repair of Tetralogy of Fallot. Circulation. 2019;140(Suppl_1):A11324-A.
• 17. Ishizaka T, Ichikawa H, Sawa Y, Fukushima N, Kagisaki K, Kondo H, et al. Prevalence and optimal management strategy for aortic regurgitation in tetralogy of Fallot. Eur J Cardiothorac Surg. 2004;26(6):1080-6.
• 18. Mongeon F-P, Ali WB, Khairy P, Bouhout I, Therrien J, Wald RM, et al. Pulmonary Valve Replacement for Pulmonary Regurgitation in Adults with Tetralogy of Fallot: A Meta-Analysis: A Report from the Writing Committee* of the 2019 Update of the Canadian Cardiovascular Society Guidelines for the Management of Adults with Congenital Heart Disease. Can J Cardiol. 2019.
• 19. Valente AM, Gauvreau K, Assenza GE, Babu-Narayan SV, Schreier J, Gatzoulis MA, et al. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart. 2014;100(3):247-53.
• 20. Yiğit H, Ergün E, Koşar PN. Cardiac Magnetic Resonance Imaging and Magnetic Resonance Angiography in Surgically Corrected Tetralogy of Fallot Patients. Turkiye Klinikleri Cardiovascular Sciences. 2019;31(1):10-20.
• 21. El Rahman MA, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange P. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart. 2000;84(4):416-20.
• 22. Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. The Lancet. 2000;356(9234):975-81.
• 23. Palmieri VJ, Fischbach P, Oster M, Stark M, Kelleman M. Does QRS duration predict exercise capacity in patients with Tetralogy of Fallot? : Am Acad Pediatrics; 2018.
• 24. Browning J, Hertzberg J, Schrorder J, Fenster B. 4D flow assessment of vorticity in right ventricular diastolic dysfunction. Bioengineering. 2017; 4:1-15.