Elective surgery for tetralogy of Fallot
can be done early, long before infants develop symptoms,
researchers said here.
There were no in-hospital deaths and the complication rate
was low — about 12 percent over about 15 years — among
asymptomatic patients under six months who were treated
at a single center, according to Roxanne Kirsch, MD, of the
Children's Hospital of Philadelphia, and colleagues.
They reported their findings during a poster session at the
Pediatric and Congenital Cardiovascular Disease meeting
here.
"Patients should be electively referred prior to the
development of symptoms," Kirsch told MedPage Today .
"Waiting for them to develop symptoms is not favorable. It
doesn't alter the ... key problem — the underlying anatomy
that needs surgical repair."
Tetralogy of Fallot is really four defects in the heart that
combine to affect oxygen levels in the blood. Children with
the condition have blue-tinged skin because the blood
flowing through their bodies doesn’t have enough oxygen.
The National Institutes of Health estimates that it affects
about 200,000 people in the United States, so it is
designated a rare condition.
Primary, complete repair of tetralogy of Fallot is an
established practice, the researchers said, and surgical
intervention during infancy has become routine in many
centers — although the optimal timing of elective surgical
intervention is still unclear, especially in asymptomatic
patients.
"We wanted to know if it's a safe and appropriate strategy,"
Kirsch told MedPage Today
So from over 500 patients, Kirsch and colleagues whittled it
down to 277 patients with the condition who'd had elective
repair between 1995 and 2009 at their institution before the
age of six months.
Kirsch said patients were excluded from their retrospective
chart review if they were older than six months when they'd
had the surgery, as well as if they'd had any complications
that could indicate being symptomatic or if they'd had prior
surgery or interventional palliation.
The median age at repair was three and half months and the
babies usually weighed about 3.5 months, and the median
weight was a little over 12 pounds.
The researchers found no in-hospital deaths, although
there were a total of 48 adverse events in 32 patients,
largely involving re-operation for bleeding and pleural/
pericardial drain placement or reintubation.
Still, the complication rate was low, Kirsch said, at less than
12 percent.
The researchers also noted that between 1995 and 2009,
there was a decrease in preoperative cardiac
catheterization and in median hospital length of stay.
Surgical volume increased over the study period, though the
use of ventriculotomy fell.
The total support time declined as well, and the use of deep
hypothermic circulatory arrest fell off significantly, which
Kirsch attributed to a "philosophical change."
When stratified by complications, the researchers saw that
those with more complications had a longer length of stay,
as might be expected. They also had more deep
hypothermic circulatory arrest, "for unclear reasons," Kirsch
said.
She noted that there was no correlation between the number
of complications and patient age.
Though the study was limited by its retrospective nature,
the findings suggest that elective repair for asymptomatic
infants with tetralogy of Fallot is safe and effective, and that
these patients should be referred for surgery early in
infancy, prior to the development of symptoms.
Kirsch said patients should be referred between two and six
months, but literature doesn't yet exist that "delineates
exactly which month is the perfect month. There may not be
a perfect month."
Tetralogy of Fallot is one of three conditions — along with
transposition of the great arteries and single-ventricle
lesions — that is being discussed in-depth here at the
meeting as researchers work to create relevant treatment
guidelines.
Please Help child
Donar please contact somnathsingh1977@gmail.com
Thank you
can be done early, long before infants develop symptoms,
researchers said here.
There were no in-hospital deaths and the complication rate
was low — about 12 percent over about 15 years — among
asymptomatic patients under six months who were treated
at a single center, according to Roxanne Kirsch, MD, of the
Children's Hospital of Philadelphia, and colleagues.
They reported their findings during a poster session at the
Pediatric and Congenital Cardiovascular Disease meeting
here.
"Patients should be electively referred prior to the
development of symptoms," Kirsch told MedPage Today .
"Waiting for them to develop symptoms is not favorable. It
doesn't alter the ... key problem — the underlying anatomy
that needs surgical repair."
Tetralogy of Fallot is really four defects in the heart that
combine to affect oxygen levels in the blood. Children with
the condition have blue-tinged skin because the blood
flowing through their bodies doesn’t have enough oxygen.
The National Institutes of Health estimates that it affects
about 200,000 people in the United States, so it is
designated a rare condition.
Primary, complete repair of tetralogy of Fallot is an
established practice, the researchers said, and surgical
intervention during infancy has become routine in many
centers — although the optimal timing of elective surgical
intervention is still unclear, especially in asymptomatic
patients.
"We wanted to know if it's a safe and appropriate strategy,"
Kirsch told MedPage Today
So from over 500 patients, Kirsch and colleagues whittled it
down to 277 patients with the condition who'd had elective
repair between 1995 and 2009 at their institution before the
age of six months.
Kirsch said patients were excluded from their retrospective
chart review if they were older than six months when they'd
had the surgery, as well as if they'd had any complications
that could indicate being symptomatic or if they'd had prior
surgery or interventional palliation.
The median age at repair was three and half months and the
babies usually weighed about 3.5 months, and the median
weight was a little over 12 pounds.
The researchers found no in-hospital deaths, although
there were a total of 48 adverse events in 32 patients,
largely involving re-operation for bleeding and pleural/
pericardial drain placement or reintubation.
Still, the complication rate was low, Kirsch said, at less than
12 percent.
The researchers also noted that between 1995 and 2009,
there was a decrease in preoperative cardiac
catheterization and in median hospital length of stay.
Surgical volume increased over the study period, though the
use of ventriculotomy fell.
The total support time declined as well, and the use of deep
hypothermic circulatory arrest fell off significantly, which
Kirsch attributed to a "philosophical change."
When stratified by complications, the researchers saw that
those with more complications had a longer length of stay,
as might be expected. They also had more deep
hypothermic circulatory arrest, "for unclear reasons," Kirsch
said.
She noted that there was no correlation between the number
of complications and patient age.
Though the study was limited by its retrospective nature,
the findings suggest that elective repair for asymptomatic
infants with tetralogy of Fallot is safe and effective, and that
these patients should be referred for surgery early in
infancy, prior to the development of symptoms.
Kirsch said patients should be referred between two and six
months, but literature doesn't yet exist that "delineates
exactly which month is the perfect month. There may not be
a perfect month."
Tetralogy of Fallot is one of three conditions — along with
transposition of the great arteries and single-ventricle
lesions — that is being discussed in-depth here at the
meeting as researchers work to create relevant treatment
guidelines.
Please Help child
Donar please contact somnathsingh1977@gmail.com
Thank you
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