Repair of tetralogy of Fallot in neonates: a single-center case series

Abstract

Background: The optimal timing for surgical intervention in the management of tetralogy remains a subject of ongoing debate. This investigation involved a retrospective analysis of neonatal patients who had received continuous treatment for tetralogy of Fallot (TOF) at our centre. The objective of this study was to examine the feasibility and necessity of treating TOF in the neonatal period.

Methods: A retrospective analytical investigation was undertaken of 33 cases of neonates who underwent consecutive one-stage surgical repair for TOF at the Beijing Anzhen Hospital from June 2022 to December 2023. The subjects had an average gestational age of 38.1 weeks (range, 31.3-40.0 weeks) and a median age at surgery of 14.0 days [interquartile range (IQR): 9.75-20.0 days]. Their mean weight at the time of surgery was 3.25±0.53 kg, and their mean pulse blood oxygen saturation (SpO₂) level was 93.0% (range, 80-98%).

Results: The mean duration for which aortic cross-clamping was performed during the surgical procedure was 74.24 minutes, with a standard deviation of ±16.33 minutes. The average duration of cardiopulmonary bypass (CPB) was 118.85±17.94 minutes. The average duration of postoperative mechanical ventilation was 110.6 hours (±89.2 hours). The patients' average postoperative intensive care unit (ICU) stay was 10 days (range, 6.75-13.25 days), and their median postoperative stay was 14 days (IQR, 11.75-15.5 days). Postoperative complications were observed in two patients (6%), who required peritoneal dialysis catheter insertion at the bedside to manage fluid imbalances. No further interventions nor mortalities occurred during the follow-up period. The median follow-up period after surgery was 201 days (range, 51-417 days).

Conclusions: The curative effect of TOF repair in the neonatal period is well-documented, with its ability to prevent the effects of pulmonary artery development and collateral circulation formation. Consequently, we suggest considering TOF repair during the neonatal period.

Keywords: Tetralogy of Fallot (TOF); neonatal period; one-stage surgical repair.

Figure 1

Pulmonary valve peak gradient at different time points measured by transthoracic echocardiograph. (A) Pulmonary valve peak gradient at birth. (B) Pulmonary valve peak gradient on the 6th day post-birth. (C) Pulmonary valve peak gradient at the most recent follow-up, 3 months post-surgery.

Figure 2

Trends in pulmonary measurements from fetal to postoperative periods. (A) Pulmonary valve peak gradient. (B) Pulmonary valve annulus diameter. (C) Left pulmonary artery diameter. (D) Right pulmonary artery diameter.