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ARTIGO ORIGINAL

Análise de fatores pré e per-operatórios determinantes do resultado cirúrgico da tetralogia de Fallot

Bayard Gontijo FilhoII; Fernando Antônio FantiniII; João Alfredo de Paula e SilvaII; Juscelino Teixeira BarbosaII; Mário Oswaldo VrandecicII; Eurival Soares BragaI; Maria da Glória Horta MasciII; Teresa Lúcia de Melo MasciII; Roberto José de Alvarenga FreireII

DOI: 10.1590/S0102-76381987000200004

RESUMO

São analisados os resultados pós-operatórios imediatos de 98 pacientes submetidos a tratamento cirúrgico da tetralogía de Fallot (TF) num total de 109 procedimentos (29 cirurgias paliativas e 80 correções definitivas). No grupo de cirurgias paliativas, ocorreram 2 óbitos no início de nossa experiência, não havendo mortalidade nos últimos 20 pacientes operados. A técnica de Blalock-Taussig clássica foi a mais utilizada (19 casos). No grupo de correção total, houve 9 óbitos (11,2%), sendo 7 deles no período de 1979 a 1983, ocorrendo apenas 2 óbitos nos últimos 42 casos operados. A presença de anastomose sistêmico-pulmonar prévia (8 casos) não interferiu na mortalidade pós-operatória. A análise retrospectiva desta experiência mostrou que os fatores que influenciaram negativamente o resultado cirúrgico foram: o baixo peso, a baixa idade, o alargamento de via de saída e alguns tipos de malformações associadas. A nossa conduta atual, baseada em uma sistematização colocada em prática a partir de 1984, prevê correção cirúrgica em 2 estágios, com tratamento paliativo antes dos 2 anos de idade. A mortalidade combinada observada nos últimos 2 anos foi de 4,7%.

ABSTRACT

We report the immediate postoperative results of 98 patients who underwent surgical treatment for tetralogy of Fallot. A paliative operation was employed in 29 children and total correction was performed in 80 patients (109 operations). There were 2 postoperative deaths in the group of paliative treatment which occurred in the beggining of our experience and no deaths were found in the last 20 operations. In the group of patients who underwent total correction there were 9 deaths (11,2%), but only 2 of these deaths occurred in the last 42 patients operated. The presence of a previous shunt (8 patients) did not interfere with the postoperative result. The factors that determined a higher postoperative mortality were: age under 2 years, weight under 10 kg, presence of transannular patch of the right ventricle and some kinds of associated anomalies. Our combined operative mortality of 4.7% in the last 2,5 years, is the support of our current choice for 2-stage surgical correction.
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