Skip to main content

Advertisement

SpringerLink
Log in

Offene Herzchirurgie bei Fallot-Tetralogie mit Pulmonalatresie: Palliation und Korrektur

Tetralogy of fallot and pulmonary atresia: Open heart surgery for palliation and repair

  • Thmenschwerpunkt: Fortschritte in der Kinderherzchirurgie
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Bei 28 aufeinanderfolgenden Patienten wurden offene Herzoperationen zur Korrektur und Palliation der Fallot-Tetralogie und Pulmonalatresie durchgeführt. Nach der Entwicklung des Pulmonalarteriensystems wurden die Patienten in folgende Gruppen eingeteilt: Gruppe I: gut ausgebildetes, zusammenhängendes Pulmonalarteriensystem mit unifokaler duktusabhängiger Durchblutung (17 Patienten); ohne (Gruppe IA) oder mit (Gruppe IB) Bifurkationsstenose. Gruppe II: hypoplastisches, zusammenhängendes oder unterbrochenes Pulmonalarteriensystem mit multifokaler Lungenperfusion (11 Patienten); >50% eines normalen Pulmonalarterienbettquerschnitts (Gruppe IIA), <50% (Gruppe IIB) sind perfundiert.

Die Operationen wurden durch Vorpalliationen kompliziert. 20 Patienten wurden korrigiert, 8 Patienten palliiert. Letalität: Gruppe I: 23,5% (4/17), IA: 9,0% (1/11). IB: 50,0% (3/6). Gruppe II: 45,4% (5/11), IIA: 33,3% (2/6). IIB: 60,0% (3/5). 4 der 5 Verstorbenen in Gruppe II waren nur palliiert worden. Die Operationen bestanden in rechtsventrikulären Ausflußtrakt-Rekonstruktionen und zum Teil prothetischen Unifokalisationen, bei Korrekturen wurde auch der Ventrikelseptumdefekt verschlossen, gegebenenfalls wurde der Verschluß wieder gefenstert. Bei Patienten der Gruppe I bevorzugen wir nunmehr die Primärkorrektur, gelegentlich auch bei Patienten der Gruppe IIA. Offene Palliationen werden in Gruppe II nur bei pulmonaler Überdurchblutung durchgeführt. Bei zyanotischen Patienten in Gruppe II sollten geschlossene, weiterführende Palliationen vorgenommen werden, die gegebenenfalls zu einer offenen Korrektur führen.

Summary

28 consecutive patients underwent open heart surgery for palliation or correction of tetralogy of Fallot and pulmonary atresia. According to their pulmonary artery anatomy they were divided as follows: Group I: Confluent pulmonary arteries. ductus dependent blood flow (17 patients): without (Group IA) or with (Group IB) bifurcation-stenosis. Group II: Hypoplastic confluent or nonconfluent pulmonary arteries fed by major aortopulmonary collateral arteries (11 patients); perfused pulmonary vascular bed >50% (Group IIA), or <50% (Group IIB) of normal. Surgery was complicated by previous palliations. 20 patients underwent corrective and 8 patients palliative procedures. Group I mortality was 23.5%, with only 9% (1/11) in IA, but 50.0% (3/6) in IB. Group II mortality was 45.4% (5/11); it was 33.3% (2/6) in IIA, but 60% (3/5) in IIB. 4 out of 5 deaths in Group II occurred in palliative procedures. Surgery comprised right ventricular outflow tract-reconstruction, and in part unifocalisation with GoreTex®-prostheses. In corrective procedures, the ventricular septal defect was closed, in some of them with a fenestrated patch. Now primary corrective procedures are preferred in all Group I patients and occasionally in Group IIA patients. Open heart surgery for palliation is only performed in high flow Group II patients. In cyanotic Group II patients, closed palliations are preferred. possibly leading to future repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Alfieri O, Blackstone EH, Kirklin JW: Surgical treatment of tetralogy of Fallot with pulmonary atresia. J Thorac Cardiovasc Surg 1978;76:321–335.

    PubMed  CAS  Google Scholar 

  2. Blackstone EH, Kirklin JW, Bertranou EG, Labrosse CJ, Soto B, Bargenan LM: Preoperative prediction from cineangiograms of post repair right ventricular pressure in tetralogy of Fallot. J Thorac Cardiovasc Surg 1979;78:542–552.

    PubMed  CAS  Google Scholar 

  3. Elzenga NJ, Suylen RJ v, Frohn-Mulder I, Essed CE, Bos E, Quaegebeur JM: Juxtaductal pulmonary artery coarctation. J Thorac Cardiovasc Surg 1990;100:416–424.

    PubMed  CAS  Google Scholar 

  4. Iyer KS, Mee RBB: Staged repair of pulmonary atresia with ventricular septal defect and major systemic to pulmonary artery collaterals. Ann Thorac Surg 1991;51:65–72.

    Article  PubMed  CAS  Google Scholar 

  5. Kirklin JW, Bargeron LM, Pacifico AD: The enlargement of small pulmonary arteries by preliminary palliative operations. Circulation 1977;56:612–617.

    PubMed  CAS  Google Scholar 

  6. Kirklin JW, Barratt-Boyes BG: Cardiac surgery. New York, Wiley, 1986, p 730.

    Google Scholar 

  7. Klinner W: Indikationsstellung und operative Technik für die Korrektur der Fallot'schen Tetralogie. Langenbecks Arch Klin Chir 1964;308:640–644.

    Article  CAS  Google Scholar 

  8. Matsuda H, Hirose H, Nakano S, Shimazaki Y, Kishimoto H, Kobayashi J, Arisawa J, Kawashima Y: Management of large aortopulmonary collateral arteries in patients with ventricular septal defect and pulmonary atresia: simultaneous ligation through median sternotomy during intracardiac repair. Ann Thorac Surg 1985;40:593–598.

    Article  PubMed  CAS  Google Scholar 

  9. McGoon DC, Baird DK, Davis GD: Surgical management of large bronchial collateral arteries with pulmonary stenosis or atresia. Circulation 1975;52:109–118.

    PubMed  CAS  Google Scholar 

  10. Millikan JS, Puga FJ, Davidson GK, Schaff HV, Julsrud PR, Mair DD: Staged surgical repair of pulmonary atresia, ventricular septal defect and hypoplastic confluent pulmonary arteries. J Thorac Cardiovasc Surg 1986;91:818–825.

    PubMed  CAS  Google Scholar 

  11. Olin CL, Ritter DG, McGoon DC, Wallace RB, Danielson GK: Pulmonary atresia. Surgical considerations and results in 103 patients undergoing complete repair. Circulation 1976;54 (suppl 3):35–40.

    Google Scholar 

  12. Puga FJ, Leoni FE, Julsrud PR, Mair DD: Complete repair of pulmonary atresia, ventricular septal defect, and severe peripheral arborization abnormalities of the central pulmonary arteries. J Thorac Cardiovasc Surg 1989;98:1018–1029.

    PubMed  CAS  Google Scholar 

  13. Rastelli GC, Ongley PA, Davis GD, Kirklin JW: Surgical repair for pulmonary valve atresia with coronary-pulmonary artery fistula: Report of a case. Mayo Clin Proc 1965;40:521–527.

    PubMed  CAS  Google Scholar 

  14. Ross DN, Somerville J: Correction of pulmonary atresia with a homograft aortic valve. Lancet 1966;II:1446–1447.

    Article  Google Scholar 

  15. Sawatari K, Imai Y, Kurosawa H, Isomatsu Y, Momma K: Staged operation for pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg 1989;98:738–750.

    PubMed  CAS  Google Scholar 

  16. Shimazaki Y, Kawashima Y, Hirose H, Nakano S, Matsuda H, Kitamura S, Morimoto S: Operative results in patients with pseudotruncus arteriosus. Ann Thorac Surg 1983;35:294–299.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Thorax-, Herz- und Gefäßchirurgie, Zentrum Chirurgie, Medizinische Hochschule Hannover, D-W-3000, Hannover 61, Deutschland

    G. Ziemer & M. Karck

  2. Abteilung Pädiatrische Kardiologie, Kinderklinik, Medizinische Hochschule Hannover, Deutschland

    Renate Kaulitz & Ingrid Luhmer

Authors
  1. G. Ziemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renate Kaulitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Karck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ingrid Luhmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ziemer, G., Kaulitz, R., Karck, M. et al. Offene Herzchirurgie bei Fallot-Tetralogie mit Pulmonalatresie: Palliation und Korrektur. Acta Chir Austriaca 25, 91–95 (1993). https://doi.org/10.1007/BF02602135

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02602135

Schlüsselwörter

Key-words

Search

Navigation