الفهرس 
EMBRYOLOGYOnly 14 pages are availabe for public view
 |  | from | 144 |  |  |
| | | from | 144 | | |
Abstract
Objectives: To assess right ventricular dilation/dysfunction at mid-to-late follow-up in tetralogy of fallot corrected by a trans-atrial/trans-pulmonary approach versus trans-annular technique at a young age and to identify risk factors associated with annular patching.
Methods: Preoperative, operative and postoperative data of 100 fallot patients who underwent total correction at cardiothoracic surgery department, Ain shams University Hospital, Cairo, Egypt, between 2013 and 2016 were retrospectively analyzed. The patients were classified into 2 groups: group I: consisting of the 63 patients operated using strategy of performing routine infundibulotomy in all cases to allow proper infundibular resection and infundibular enlargement (TAP) group II: 37 patients operated to a uniform strategy that aimed to minimize postoperative pulmonary regurgitation This strategy techniques: trans-atrial/trans-pulmonary approach, Pulmonary annulus sparing technique, Preservation of good functioning pulmonary leaflets, and Avoiding or minimizing infundibulotomy.
Results: Regarding McGoon ratio (PA branch sizes). TAP is 2.11 ± 0.40., RA-PA approach is 2.41 ± 0.93 sharing almost same ratio around 2 ,While regarding Echo-graphic findings comparing group I and group II regarding Right ventricle function and size pre-operatively with no statistically significant for most data except right ventricle size mild to moderate dilatation was 93% in group I while in group II was72%, regarding operative The result showed a significant statistical difference in bypass time Between both groups, were significantly lower in group II than group I (89.12 ± 19.37for group I 84.86 ± 21.69 for group II, P – value 0.031). While ischemic time statically had no difference. Comparison between group I group II as regard immediate postoperative data, Intensive care unit and hospital stay findings showed a statistical difference comparing group I and group II considering ICU stay(8.07 ± 7.88 for group I 5.40 ± 1.77 for group II .P – value< 0.001). While hospital stay was 12.49 ± 8.4for group I8.45 ± 2.15 for group II, P – value< 0.001). Comparison between the group I and group II late post-operatively regarding the echography of the heart shows statistically significant difference for Pulmonary regurge, RV size, RV function, RV EDV, for the benefit of group II while RVOT PG for the benefit of group I. Pulmonary regurge (Moderate) 46%for group I 21.6% for group II Sever 22.2% for group I and no patients in group II had a sever regurge, RV size Moderate dilatation 52.5% for group I ,13.5% for groupII. Severe dilatation for group I 21.3% for group II 8.1%, RV function Fair for group I 21.3%. For group II 13.5% Impaired function for group I14.8%, no patients from the group II had Impaired function while RVOT PG for group I 19.03 ± 13.59, 32.51 ± 16.29 group II. Comparison between group I and group II as regard post-operative MRI assessment of heart show an improvement in all aspects regarding group 2. RV ESV (ml/m2) for group I 103.18 ± 11.94 for group II 67.50 ± 2.12(P – value: 0.028), RV EDV (ml/m2) for group I 187.72 ± 29.29 for group II 100.50 ± 0.70 (P – value: 0.028).
CONCLUSION: Every effort should be done in order to minimize or even avoid the pulmonary regurgitation in total correction of Fallot’s tetralogy, so decreasing the right ventricle dysfunction, and MRI should be the standard tool for TOF investigations.