Clinical Study to Individual Treatment for Major Aortopulmonary Collaterals of Tetralogy of Fallot.

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)/Wt) 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)/Wt), 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.