PDF(Pubmed)
Abstract：
BACKGROUND: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD) worldwide. It accounts for 7% of CHD cases in Uganda and leads to fatal outcomes in the long term without surgery. Surgery is often delayed in developing countries like Uganda due to limited resources.
OBJECTIVE: This study aimed to determine the early surgical outcomes of patients with TOF who underwent primary intracardiac repair at the Uganda Heart Institute (UHI) and to identify factors associated.
METHODS: This retrospective chart review evaluated outcomes of primary TOF repair patients at UHI from February 2012 to October 2022. Patient outcomes were assessed from surgery until 30 days post-operation.
RESULTS: Out of the 104 patients who underwent primary TOF repair at UHI, records of 88 patients (84.6%) were available for review. Males accounted for 48.9% (n = 43). The median age at the time of operation was 4 years (with an interquartile range of 2.5-8.0 years), ranging from 9 months to 16 years. Genetic syndromes were present in 5/88 (5.7%). These included 2 patients with trisomy 21, 2 with Noonan\'s, and 1 with 22q11.2 deletion syndrome. Early postoperative outcomes for patients included: residual ventricular septal defects in 35/88 (39.8%), right ventricular dysfunction in 33/88 (37.5%), residual pulmonary regurgitation in 27/88 (30.7%), residual right ventricular outflow tract obstruction in 27/88 (30.0%), pleural effusion in 24/88 (27.3%), arrhythmias in 24/88(27.3%), post-operative infections in 23/88(26.1%) and left ventricular systolic dysfunction in 9/88 (10.2%). Out of the children who underwent surgery after one year of age, 8% (7 children) died within the first 30 days. There was a correlation between mortality and post-operative ventilation time, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, preoperative oxygen saturations, RV and LV dysfunction and the operating team.
CONCLUSIONS: The most frequent outcomes after surgery were residual ventricular septal defects and right ventricular failure. In our study, the 30-day mortality rate following TOF repair was 8%. Deceased patients had lower pre-operative oxygen levels, longer CPB and cross-clamp times, longer post-operative ventilation, RV/LV dysfunction, and were more likely operated by the local team.
OBJECTIVE: This study aimed to determine the early surgical outcomes of patients with TOF who underwent primary intracardiac repair at the Uganda Heart Institute (UHI) and to identify factors associated.
METHODS: This retrospective chart review evaluated outcomes of primary TOF repair patients at UHI from February 2012 to October 2022. Patient outcomes were assessed from surgery until 30 days post-operation.
RESULTS: Out of the 104 patients who underwent primary TOF repair at UHI, records of 88 patients (84.6%) were available for review. Males accounted for 48.9% (n = 43). The median age at the time of operation was 4 years (with an interquartile range of 2.5-8.0 years), ranging from 9 months to 16 years. Genetic syndromes were present in 5/88 (5.7%). These included 2 patients with trisomy 21, 2 with Noonan\'s, and 1 with 22q11.2 deletion syndrome. Early postoperative outcomes for patients included: residual ventricular septal defects in 35/88 (39.8%), right ventricular dysfunction in 33/88 (37.5%), residual pulmonary regurgitation in 27/88 (30.7%), residual right ventricular outflow tract obstruction in 27/88 (30.0%), pleural effusion in 24/88 (27.3%), arrhythmias in 24/88(27.3%), post-operative infections in 23/88(26.1%) and left ventricular systolic dysfunction in 9/88 (10.2%). Out of the children who underwent surgery after one year of age, 8% (7 children) died within the first 30 days. There was a correlation between mortality and post-operative ventilation time, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, preoperative oxygen saturations, RV and LV dysfunction and the operating team.
CONCLUSIONS: The most frequent outcomes after surgery were residual ventricular septal defects and right ventricular failure. In our study, the 30-day mortality rate following TOF repair was 8%. Deceased patients had lower pre-operative oxygen levels, longer CPB and cross-clamp times, longer post-operative ventilation, RV/LV dysfunction, and were more likely operated by the local team.
摘要：
背景：法洛四联症（TOF）是全球最常见的紫红色先天性心脏病（CHD）。它占乌干达冠心病病例的7％，长期不手术导致致命的结果。在乌干达等发展中国家，由于资源有限，手术经常被推迟。
目的：本研究旨在确定在乌干达心脏研究所（UHI）接受原发性心内修复的TOF患者的早期手术结果，并确定相关因素。
方法：本回顾性图表评估了2012年2月至2022年10月在UHI治疗的原发性TOF修复患者的结局。从手术直到手术后30天评估患者结果。
结果：在UHI接受原发性TOF修复的104例患者中，88例患者(84.6%)的记录可供查阅.男性占48.9%(n=43)。手术时的中位年龄为4岁（四分位距为2.5-8.0岁），从9个月到16年不等。5/88（5.7％）存在遗传综合征。其中包括2例21三体，2例Noonan\s，1与22q11.2缺失综合征。患者术后早期结果包括：35/88的残余室间隔缺损（39.8%），33/88（37.5%）右心室功能障碍，27/88（30.7%）的残余肺返流，残余右室流出道梗阻27/88(30.0%),24/88胸腔积液（27.3%），24/88的心律失常（27.3%），术后感染23/88（26.1％），左心室收缩功能障碍9/88（10.2％）。在一岁后接受手术的儿童中，8%(7名儿童)在前30天内死亡。死亡率和术后通气时间之间存在相关性，体外循环(CPB)时间,主动脉交叉钳夹时间,术前氧饱和度,RV和LV功能障碍和手术团队。
结论：手术后最常见的结果是残余室间隔缺损和右心室衰竭。在我们的研究中,TOF修复后30天死亡率为8%.死亡患者术前氧气水平较低，更长的CPB和交叉夹紧时间，术后通气时间延长，RV/LV功能障碍,更有可能由当地团队操作。
目的：本研究旨在确定在乌干达心脏研究所（UHI）接受原发性心内修复的TOF患者的早期手术结果，并确定相关因素。
方法：本回顾性图表评估了2012年2月至2022年10月在UHI治疗的原发性TOF修复患者的结局。从手术直到手术后30天评估患者结果。
结果：在UHI接受原发性TOF修复的104例患者中，88例患者(84.6%)的记录可供查阅.男性占48.9%(n=43)。手术时的中位年龄为4岁（四分位距为2.5-8.0岁），从9个月到16年不等。5/88（5.7％）存在遗传综合征。其中包括2例21三体，2例Noonan\s，1与22q11.2缺失综合征。患者术后早期结果包括：35/88的残余室间隔缺损（39.8%），33/88（37.5%）右心室功能障碍，27/88（30.7%）的残余肺返流，残余右室流出道梗阻27/88(30.0%),24/88胸腔积液（27.3%），24/88的心律失常（27.3%），术后感染23/88（26.1％），左心室收缩功能障碍9/88（10.2％）。在一岁后接受手术的儿童中，8%(7名儿童)在前30天内死亡。死亡率和术后通气时间之间存在相关性，体外循环(CPB)时间,主动脉交叉钳夹时间,术前氧饱和度,RV和LV功能障碍和手术团队。
结论：手术后最常见的结果是残余室间隔缺损和右心室衰竭。在我们的研究中,TOF修复后30天死亡率为8%.死亡患者术前氧气水平较低，更长的CPB和交叉夹紧时间，术后通气时间延长，RV/LV功能障碍,更有可能由当地团队操作。
