A. H. Siddiqui1, H. Fatima2, F. Safi2, M. Amanullah1 1Aga Khan University Medical College,Department Of Surgery,Karachi, Sindh, Pakistan 2Aga Khan University Medical College,Medical College,Karachi, Sindh, Pakistan
Introduction:
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease in the world, and survival into adulthood is well known. Patients with untreated disease seldom present in the developed world; however, it is not uncommon in developing countries. Over time the development of comorbidities give rise to a major surgical challenge. We aimed to establish the relationship between pre-operative characteristics and post-operative course in these patients.
Methods:
We conducted a retrospective chart review of all patients older than the age of 10 years who underwent surgical repair of TOF between July 2006 and February 2017. Primary outcome measures were early (30-day) and late (greater than 30-day) mortality, morbidity, and need for reintervention. Data was analyzed using SPSS v 21.
Results:
A total of 59 patients meeting the inclusion criteria underwent surgical repair of TOF. The mean age at repair was 18.81 (±5.53) years. 6 (10.0%) patients had a pre-operative New York Heart Association (NYHA) functional class of I, 29 (48.3%) were NYHA class II, 12 (20.0%) were NYHA class III and 3 (5.0%) were NYHA class IV. All patients had atrial and ventricular arrythmias on electrocardiogram. Cyanotic spells were seen in 30 (50.8%) patients. 11 (18.6%) patients reported pre-operative palpitations, 11 (18.6%) had chest pain, whereas 9 (15.3%) had a history of infective endocarditis. 11 patients had undergone a previous Blalock-Taussig shunt (BT shunt) procedure.
There was 1 (1.69%) 30-day mortality seen, which was due to a ventricular arrythmia. No late mortalities were seen. The most common post-operative complication was pneumonia, seen in 8 (13.6%) patients, followed by sepsis seen in 6 (10.2%) patients. The mean length of ICU stay was 2.5 (±2.1) days. 3 (5.08%) patients needed a reintervention: one for severe post-operative pulmonary stenosis, one for residual ventricular septal defect (VSD) and pulmonary regurgitation and one for residual atrial septal defect (ASD).
Conclusion:
A significant number of adults with Tetralogy of Fallot are surgically treated in Pakistan, as in other developing countries. The overall morbidity and mortality of surgical intervention in this cohort is acceptable at our institution and comparable to that reported in other studies.