Clinical Study to Individual Treatment for Major Aortopulmonary Collaterals of Tetralogy of Fallot. (15th May 2019)

• Record Type: Journal Article
• Authors: Guan, Qing; Li, Jiarong; Deng, Kai; Wu, Xiaoming; Tang, Shiyuan; Fan, Chengming; Wu, Xun; Yuan, Shuwen; Yang, Jinfu
• Other Names: Vida Vladimiro Academic Editor.
• Is Part Of: BioMed research international. Volume 2019(2019)
• Publication Date: 2019-05-15
• Subjects: Medicine -- Periodicals; Biology -- Periodicals; Biotechnology -- Periodicals; Life sciences -- Periodicals; 610.5
• DOI: 10.1155/2019/1603712
• Languages: English
• ISSNs: 2314-6133

Abstract

Abstract : Objectives . To build a guideline for the individual treatment of Tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) and tentatively establish the occlusion index of MAPCAs. Methods . According to the diameter of the aortopulmonary collaterals (R: mm) and the bodyweight of the children (weight: kg), K= (( ∑ R 2 ) / W t ) was set as the occlusion index of TOF with MAPCAs. A retrospective study was initially performed in 171 patients who suffered from TOF with MAPCAs and underwent cardiac malformation repair to investigate the intervals of the K value: K≥2, 1<K<2, and K≤1. In order to examine the reliability of the intervals derived from the retrospective study, a prospective study was conducted in the following 209 cases. When K≥2, the collaterals occlusion was performed immediately behind surgical corrections. The postoperative condition changes in patients with 1<K<2 were observed first and managed by extending mechanical ventilation, while taking further treatments as their conditions worsen. As for patients with K≤1, no occlusion was performed. Finally, the circumstances of collaterals occlusion, postoperative ventilator assist time, and ICU resident time were collected and analyzed. Result . The proportion of the patients treated with occlusion and the postoperative ICU resident time (p<0.05) in patients with 1<K<2 in the prospective study did dramatically decrease when compared with those of the retrospective studies. Conclusion . Due to restrictions on medical conditions in China with a large population base, a standard individual treatment of TOF with MAPCAs should be established based on the Aortopulmonary Collaterals Occlusion Index K= (( ∑ R 2 ) / W t ), which can effectively avoid unnecessary collateral occlusion, minimize trauma, and shorten the length of ICU and hospital stay. When K≥2, the collateral occlusion and surgical correction are recommended to be performed simultaneously. When 1<K<2, whether to occlude collaterals depends on the patients' postoperative conditions with extending ventilator time. When K≤1, do not deal with collaterals.