Abstract Ref Number = APCP214
Surgical Decision of Tetralogy of Fallot in Cipto Mangunkusumo Hospital
Bagus Artiko,Mulyadi M Djer,Piprim B Yanuarso,Najib Advani,Rubiana Sukardi,Jusuf Rachmat
Sebelasmaret University Departement of Child Health Pediatric Cardiology subdivision, Department of Child Health, Medical Faculty, Indonesia University, Jakarta Pediatric Cardiology , Integrated Cardiac Services, Cipto Mangunkusumo Hospital, Jakarta Cardiac Thoracic and Vascular Surgery Departement, Medical Faculty, Indonesia University, Jakarta
Background : Tetralogy of Fallot is the most common cyanotic congenital heart disease. Surgery decision is often based on Nakata index (> 200 mm2/m2), McGoon ratio (> 1.5) and half size criteria. The purpose of this study is to summarize our experience of surgical treatment of this complex lesion.
Material : This retrospective descriptive study included 85 patients with tetralogy of Fallot underwent surgical intervention in Cipto Mangunkusumo Hospital from May 2017 to April 2018. Pulmonary arterial Nakata index was used for the quantitative assessment of the pulmonary artery. A half size criterion was used to assist surgery decision. Final surgery decision was recorded, and the data shown as descriptive analysis.
Results : A total of 73 subjects were eligible for the study. Age of patients ranged from 4 months to 40 years (median 38 months). 54 patients underwent complete repair of tetralogy of Fallot, 8 patients underwent Rastelli procedure, and 11 patients underwent Blalock–Taussig shunt (BT Shunt) procedure. Hospital mortality post-surgery reached 12.3%. BT shunt decision which made based on Nakata Index < 200 mm2/m2 were 8 patients, the other 3 patients based on stenosis of pulmonary artery branch. BT shunt decision which made based on Half Size < criterions were 9 Patients, the other 2 patients based on stenosis of pulmonary artery branch. 8 patients did not meet Nakata and Half size criteria but underwent total correction anyway. From those patients, there was one mortality (Nakata index 125 mm2/m2); the other 7 patients Nakata indexes were > 150 mm2/m2. The other post-surgical mortality caused by surgical difficulties (3 patient); sepsis (1 patients); and another comorbid disease (4 patients).
Conclusions : Nakata index greater than 150 mm2/m2 might be a suitable criterion for a successful complete repair. Nakata index should always be considered in surgery decision making.
Keywords: Tetralogy of Fallot Nakata Index Half Size