A successfully operated case of high-aged tetralogy of Fallot with marked left ventricular dysfunction Akira Itoh 1 , Shumpei Okubo 1 , Norifumi Nakanishi 1 , Takao Yoshioka 1 , Takeyoshi Kunieda 1 , Kohei Kawazoe 2 , Yoshitsugu Kito 2 1Division of Cardiology, National Cardiovascular Center 2Cardiovascular Surgery, National Cardievascular Center Keyword: 高齢ファロー四徴症(high-aged TOF) , 左室機能低下(left ventricular dysfunction) , 根治手術(total correction) pp.909-912
Published Date 1990/9/15
DOI https://doi.org/10.11477/mf.1404910015
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Adults, especially high-aged patients with tetra-logy of Fallot (TOF) are said to have a higher operative risk than younger ones because of fragility of their myocardium, bleeding from rich collateral circulation to lungs, and other complications such as brain abscess and endocarditis. It is often difficult to determine the surgical risk for total correction in cases of high-aged patients who have such com-plications. We report a successfully operated high-aged case of TOF with marked left ventricular dys-function. A 52-year-old male was reffered to our hospital because of exertional dyspnea and cyanosis. He had a history of cerebral embolism and menin-gitis several months prior to admission. On admis-sion, he was NYHA class 3, and cyanosis and club-bed fingers were present. Cardiac catheterization showed a large VSD, 50% over-riding of the aorta and an infundibular pulmonary stenosis. Right to left shunt was 60% and Qp/Qs was 0.38. The left ventricular end diastolic volume index was 109ml/ m2, slightly larger than normal, and the ejection fraction was only 30%. This left ventricular dysfunc-tion was thought to be caused by fibrosis of the myocardium due to longstanding hypoxemia and hypoxemia itself. There is no previous case report dealing with a successful total correction for a high-aged patient with TOF associated with such a severe left ventricular dysfunction. Congestive heart failure in the post-operative period was successfully treated by catecholamine for two weeks. Post-operative cardiac catheterization showed a small left-to-right shunt, and an improvement of left venricular ejec-tion fraction from 30% to 38%. After the opera-tion, he was NYHA class 2, and had no cyanosis. This case showed that total correction is feasible even for such a high-aged, poor risk patient with TOF.

Copyright © 1990, Igaku-Shoin Ltd. All rights reserved.


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