Clinical Studies of Tetralogy of Fallot : Factors Affecting Outcome of Operation

Kim, Hong Jin; Sui, Jun Hee; Lee, Sung Kyu; Chin, Dong shick; Hong, Sung Nok

Abstract

Tetralogy of Fallot is one of the most common cyanotic congenital heart disease. It consists of four features anatomically pulmonic stenosis or atresia, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. One hundred and ninety one cases of Tetralogy of Fallot were confirmed by cardiaccatheterization at Severance Hospital. These were observed on general feature, cardiac catheterization findings and outcome of operation during the period from Jan. 1964 to Dec. 1980. The results of this study may be summerized briefly at follows: 1. Out of the 27365 admitted patients, 1132 cases had congenital heart disease, and 191 cases were Tetralogy of Fallot. This amounted to 16.9% of all those with congenital heart disease. 2. Of the 191 cases, 127 were males and 64 were females. 3. The electrocardiographic findings showed 147 cases of right axis deviation(84.0%), 144 cases of right ventricular hypertrophy(83.1%). Chest P-A revealed that normal cardiothoracic ratio were 137 cases(74.8%), and cardiac apex elevation were 126 cases(68.8%). 4. Pulmonic stenosis were chiefly valvular and infundibular stenosis on cardiac catheterization of 191 cases of TOF(68.6%). 5. The cardiac disease associated with TOF were 80 cases in all; 59 cases with patient formen ovale, 11 cases with atrial secundum defect. 6. There were significant correlation between secondary polycythemia and thrombocytopenia. 7. Complications of TOF were 3 cases of infective endocarditis, 3 cases of cerebral thromboembolism and 1 case of brain abscess. 8. Among 191 cases, only 146 cases received operation, and over all fatality rate were 20.9%. The number of patients with total correction were 89 cases, 42 cases with shunt operation, and 15 cases with total correction after shunt operation. The fatality rate of operation was worst in the group, who received total correction after shunt operation(46.6%). The were 8 cases in group 1, 154 cases in group 2, and 29 cases in group 3 by Nadas classification. The fatality rate in group 1 was higher than any other groups(42.8%). The group with the ratio of main pulmonary artery to aorta size with less than 1/3, showed the highest fatality rate(50%) than other groups.