Тетрада Фалло – «Старый» порок в XXI веке – нерешенные вопросы этапной хирургической коррекции

П.Ф. Черноглаз

ГУ «РНПЦ детской хирургии», г. Минск

Несмотря на то, что порок известен давно, разработаны методы хирургической коррекции, позволяющие достичь прекрасных непосредственных и отдаленных результатов, до сих пор до конца не решены тактические вопросы этапной коррекции порока в ситуациях, когда первичная радикальная коррекция невозможна в силу таких причинкак тяжелое исходное состояние, малый вес пациента, недоразвитие ветвей легочной артерии (ЛА). Помимо классических межсистемных анастомозов по Блелок-Тауссиг в клиническую практику внедряются такие эндоваскулярные методики поддержания легочного кровотока как стентирование выносящего тракта правого желудочка (ВТПЖ) и стентирование открытого артериального протока (ОАП). Данные методики при всех преимуществах миниинвазивных технологий в определенных клинических и анатомических ситуациях не уступают, а в большинстве случаев превосходят классические хирургические методики.

ключевые слова: врожденный порок сердца, тетрада Фалло, открытый артериальный проток, стентирование, анастомоз по Блелок-Тауссиг

для цитирования: П.Ф. Черноглаз. Тетрада Фалло – «Старый» порок в XXI веке – нерешенные вопросы этапной хирургической коррекции Неотложная кардиология и кардиоваскулярные риски, 2021, Т. 5, № 1, С. 1210–1216.

Tetralogy of Fallot – «Old» congenital heart defect in the xxi century – unresolved questions of stage-by-stage surgical correction

P.F. Charnahlaz

Despite the fact that the defect has been known for a long time and methods of surgical correction have been developed that allow achieving excellent immediate and long-term results, the tactical issues of stage-by-stage correction of the defect in situations where primary radical correction is impossible due to such reasons as a severe initial condition, low weight of the patient, underdevelopment of the branches of the pulmonary artery (PA) have not yet been fully resolved. In addition to classical Blalock-Taussig intersystem anastomoses, such endovascular techniques of maintaining pulmonary blood flow as stenting of the right ventricular outflow tract (RVOT) and stenting of the patent ductus arteriosus (PDA) are being introduced into clinical practice. These techniques, with all the advantages of minimally invasive technologies in certain clinical and anatomical situations, are not inferior, and in most cases surpass classical surgical techniques.

keywords: tetralogy of Fallot, patent ductus arteriosus, stenting, congenital heart defect, Blalock-Taussig shunt

for references: P.F. Charnahlaz. Tetralogy of Fallot – «Old» congenital heart defect in the XXI century – unresolved questions of stage-by-stage surgical correction. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2021, vol. 5, no. 1, pp. 1210–1216.

REFERENCES
1. Van der Linde D., Konings E.E., Slager M.A., Slager M.A., Witsenburg M., Helbing W.A., Takkenberg J.J.M., Roos-Hesselink J.W. Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. J Am Coll Cardiol. 2011, vol. 58, no. 21, pp. 2241-2247. doi: 10.1016/j.jacc.2011.08.025.
2. Burakovskiy V.I. Bokeriya L.A. eds. Serdechno-sosudistaya hirurgiya: rukovodstvo [Cardiovascular surgery: a guide]. M., Medicina, 1996, 768 s. (in Russian).
3. Kirklin J.W. Kirklin J.W., Barratt-Boyes B.G. Cardiac Surgery, 2003, 1419 p.
4. Neill C.A., Clark E.B. Tetralogy of Fallot. The first 300 years. Tex Heart Inst J, 1994, vol. 21, no. 4, pp. 272-279.
5. Fallot E.L.A. Contribution à l’anatomie pathologique de la maladie bleue (cyanose cardiaque). Marseille Médical, 1888, vol. 25, pp. 77-93.
6. Lillehei C.W., Cohen M., Warden H.E. Read R.C., Aust J.B., Dewall R.A., Varco R.L. Direct vision intracardiac surgical correction of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary atresia defectsvol. report of first ten cases. Ann Surg, 1955, vol. 142, no. 3, pp. 418-442. doi: 10.1097/00000658-195509000-00010.
7. Kirklin J.W., Blackstone E.H., Pacifico A.D., Kirklin J.K., Bargeron Jr.L.M. Risk factors for early and late failure after repair of tetralogy of Fallot, and their neutralization. Thorac cardiovasc Surg, 1984, vol. 32, no. 4, pp. 208-214. doi:10.1055/s-2007-1023386.
8. Lillehei C.W., Varco R.L., Cohen M., Warden H.E., Gott V.L., DeWall R.A., Patton C., Moller J.H. The first open heart corrections of tetralogy of Fallot. A 26-31 year follow-up of 106 patients. Ann Surg, 1986, vol. 204, no. 4, pp. 490-502. doi: 10.1097/00000658-198610000-00017.
9. Carvalho J.S., Shinebourne E.A., Busst C., Rigby M.L., Redington A.N. Exercise capacity after complete repair of tetralogy of Fallot: Deleterious effects of residual pulmonary regurgitation. Br Heart J, 1992, vol. 67, no. 6, pp. 470-473. doi: 10.1136/hrt.67.6.470.
10. Kirklin J.W., Wallace R.B., McGoon D.C., DuShane J.W. Early and late results after intracardiac repair of Tetralogy of Fallot. 5-Year review of 337 patients. Ann Surg, 1965, vol. 162, no. 4, pp. 578-89. doi: 10.1097/00000658-196510000-00004.
11. Carvalho J.S., Shinebourne E.A., Busst C., Rigby M.L., Redington A.N. Exercise capacity after complete repair of tetralogy of Fallot: Deleterious effects of residual pulmonary regurgitation. Br Heart J, 1992, vol. 67, no. 6, pp. 470-473. doi: 10.1136/hrt.67.6.470.
12. Khairy P., Landzberg M.J., Gatzoulis M.A., Lucron H., Lambert J., Marçon F., Alexander M. E., Wals E.P. Value of programmed ventricular stimulation after tetralogy of fallot repair: A multicenter study. Circulation, 2004, vol. 109, no. 16, pp. 1994-2000. doi: 10.1161/01.CIR.0000126495.11040.BD.
13. Kirklin J.W., Wallace R.B., McGoon D.C., DuShane J.W. Early and late results after intracardiac repair of Tetralogy of Fallot. 5-Year review of 337 patients. Ann Surg, 1965, vol. 162, no. 4, pp. 578-589. doi: 10.1097/00000658-196510000-00004.
14. Nakashima K., Itatani K., Oka N., Kitamura T., Horai T., Hari Y., Miyaji K. Pulmonary Annulus Growth After the Modified Blalock-Taussig Shunt in Tetralogy of Fallot. Ann Thorac Surg, 2014, vol. 98, no. 3, pp. 934-940. doi: 10.1016/j.athoracsur.2014.04.083.
15. Daliento L., Mapelli D., Russo G., Scarso P., Limongi F., Iannizzi P., Melendugno A., Mazzotti E., Volpe B. Health related quality of life in adults with repaired tetralogy of Fallot: Psychosocial and cognitive outcomes. Heart, 2005, vol. 91, no. 2, pp. 213-218. doi: 10.1136/hrt.2003.029280.
16. Loomba R.S., Buelow M.W., Woods R.K. Complete Repair of Tetralogy of Fallot in the Neonatal Versus Non-neonatal Period: A Meta-analysis. Pediatr Cardiol, 2017, vol. 38, no. 5, pp. 893-901. doi: 10.1007/s00246-017-1579-8.
17. Bakhtiary F., Dähnert I., Leontyev S., Schröter T., Hambsch J., Mohr F. W., Martin Kostelka Ph.D. Outcome and Incidence of Re-Intervention After Surgical Repair of Tetralogy of Fallot. J Card Surg, 2013, vol. 28, no. 1, pp. 59-63. doi: 10.1111/jocs.12030.
18. Arenz C., Laumeier A., Lütter S., Blaschczok H.C., Sinzobahamvya N., Haun C., Asfour B., Hraska VIs there any need for a shunt in the treatment of tetralogy of Fallot with one source of pulmonary blood flow? Eur J Cardio-Thoracic Surg, 2013, vol. 44, no. 4, pp. 648-654. doi:10.1093/ejcts/ezt124.
19. Bokeriya L.A., Tumanyan M.R., Zelenikin M.A., SHatalov K.V., Prasolov S.YU., Musatova T.I., Arnautova I.V., Dedushkina N.YU., Bokova N.A. Analiz blijayshih rezul’tatov hirurgicheskogo lecheniya tetrady Fallo u detey rannego vozrasta [Analysis of the immediate results of surgical treatment of tetralogy of Fallot in young children]. Grudnaya i serdechno-sosudistaya hirurgiya,2001, no. 1, pp. 4. (in Russian).
20. Zelenikin M.A., Prasolov S.YU., SHatalov K.V., Arnautova I.V., Dedushkina A.A., Kupryashov A.A. Taktika hirurgicheskogo lecheniya tetrady’ Fallo u pacientov rannego vozrasta [Tactics of surgical treatment of tetralogy of Fallot in young patients]. Vos’moy Vserossiyskiy s`ezd serdechno-sosudisty’h hirurgov, Moskva, 18-22 noyab. 2002 g. : tez. dokl. Moskva, 2002, S. 30. (in Russian).
21. Alkhulaifi A.M. Lacour-Gayet F., Serraf A., Belli E., Planche С. Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach. Ann Thorac Surg, 2000, vol. 69, pp. 1499-1504.
22. Odiyankov E.G., Fahreev I.I., Gureeva V.N., Anisimov S.V., Zagrebin A.L., Ry’kov V.V., Savel’ev A.V., Gaynutdinov V.O. Operaciya Blelok-Taussig v hirurgii tetrady’ Fallo i atrezii trikuspidal’nogo klapana [Blelock-Taussig surgery in Fallot Tetrad surgery and tricuspid valve Atresia]. Vos’moy Vserossiyskiy s`ezd serdechno-sosudisty’h hirurgov, Moskva, 18-22 noyab. 2002 g. : tez. dokl. Moskva, 2002, S. 34. (in Russian).
23. Uzakov N.U., Karakozov P.E., Hikmatov A.A., Abrolov H.K., Achilov E.M. Mejarterial’ny’e anastomozy’ v hirurgicheskom lechenii tetrady Fallo [Interarterial Anastomoses in the surgical treatment of tetralogy of Fallot]. VI Vserossiyskiy s`ezd serdechno-sosudisty’h hirurgov : tez. dokl. Moskva, 2000, S. 22. (in Russian).
24. Kirklin J.W., Bargeron E.M. Jr., Pacifico A.D. The enlargement of small pulmonary arteries by preliminary palliative operations. Circulation, 1977, vol. 56, pp. 612.
25. Gorbaty’h Yu.N., Naberuhin Yu.L., Molin A.V., Novikova M.A., Chaschin O.V., Kasatkin A.S., Ivancov S.M., Varand E.V. K voprosu taktiki hirurgicheskogo lecheniya tetrady’ Fallo u detey do 3-h let [On the tactics of surgical treatment of tetrad Fallot in children under 3 years of age]. CHetvertaya ejegodnaya sessiya nauchnogo centra serdechno-sosudistoy hirurgii im. A. N. Bakuleva s Vserossiyskoy konferenciey molody’h ucheny’h, Moskva, 14-16 maya 2000 g. : tez. dokl. Moskva, 2000. S. 12. (in Russian).
26. Gorbaty’h YU.N. Naberuhin YU.L., Hapaev T.S., Ivancov S.M., Molin A.V., Kasatkin A.S., Chasch’in O.V. Sravnitelnyy analiz neposredstvenny’h rezul’tatov sistemno-legochny’h anastomozov, sozdannyh s pomosch’’yu sosudistyh protezov «Gore-Tex» i ksenoprotezov u bolnyh s cianoticheskimi VPS [Comparative analysis of direct results of systemic-pulmonary anastomoses created with the help of “Gore-Tex” vascular prostheses and xenoprostheses in patients with cyanotic CHD]. SHestaya ejegodnaya sessiya Nauchnogo centra serdechno-sosudistoy hirurgii im. A.N. Bakuleva RAMN s Vserossiyskoy konferenciey molody’h ucheny’h, Moskva, 12-14 Maya 2002 g. : tez. dokl. Moskva, 2002, S. 13. (in Russian).
27. Ilin V.N., Ivanickiy A.V., Sharykin A.S., Vedernikova L.A., CHechneva V.V., Sonnova S.N., Vinokurov A.V., Zubkova G.A., Koryagin D.A., Abramyan M.A. E`ffektivnost’ selektivnoy hirurgicheskoy taktiki i modifikaciy operativnoy tehniki korrekcii tetrady Fallo u detey 1-go goda jizni: rezultaty 100 posledovatelnyh operaciy [The effectiveness of selective surgical tactics and modifications of surgical techniques for correcting the Fallot tetrad in children of the 1st year of life: the results of 100 consecutive operations]. VI Vseros-siyskiy s`ezd serdechno-sosudisty’h hirurgov : tez. dokl. Moskva, 2000, S. 10. (in Russian).
28. Lyubomudrov V.G., Kungurcev V.L., Bolsunovskiy V.A., Menshugin I.N., Cy’tko A.L., Mihaylova E.V. Radikal’naya korrekciya tetrady’ Fallo bez kateterizacii serdca [Radical correction of the Fallot tetrad without cardiac catheterization]. III Vserossiyskiy s`ezd serdechno-sosudisty’h hirurgov, Moskva, 17-20 dek. 1996 g. : tez. dokl. i soobsch’. Moskva, 1996, S. 65. (in Russian).
29. Alfieri О., Locatelli G., Bianchi Т., Vanini V., Parenzan L. Repair of tetralogy of Fallot after Waterston anastomosis. J Thorac Cardiovasc Surg, 1979, vol. 77, pp. 826.
30. Cobanoglu A., Schultz J.M. Total correction of tetralogy of Fallot in the first year of life: late results. Ann Thorac Surg, 2002, vol. 74, P. 133-138.
31. Bolsunovskiy V.A., Lyubomudrov V.G., Kungurcev V.L., Menshugin I.N., Shagal A.E., Sulkovskaya L.S., Zorin A.B. Neposredstvenny’e i otdalenny’e rezul’taty’ primeneniya podklyuchichno-legochnogo shunta pri korrekcii vrojdenny’h porokov serdca [Immediate and long-term results of the subclavian-pulmonary shunt in the correction of congenital heart defects]. III Vserossiyskiy s`ezd serdechno-sosudisty’h hirurgov, Moskva, 17-20 dek. 1996 g. : tez. dokl. i soobsch’. Moskva, 1996, S. 72. (in Russian).
32. Vityazev S.P., Volkov A.M., Karaskov A.M., Litasova E.E. Dinamika patofiziologicheskih, angiograficheskih i morfofunkcionalnyh izmeneniy do i posle palliativnyh operaciy [Dynamics of pathophysiological, angiographic, and morphofunctional changes before and after palliative surgery]. Pyataya ejegodnaya sessiya Nauchno-go centra serdechno-sosudistoy hirurgii im. A.N. Bakuleva RAMN s Vserossiyskoy konferenciey molody’h ucheny’h : tez. dokl. Moskva, 2001, S. 21. (in Russian).
33. Lillehei C.W., Levy M.J., Adams P., Anderson R.C. Corrective surgery for tetralogy of Fallot. J Thorac Cardivasc Surg, 1964, vol. 48, pp. 556.
34. Johnson R.G., Haworth S.G. Pulmonary vascular and alveolar development, vol. in tetralogy of Fallot: a recommendation for early correction. Thorax, 1982, vol. 37, pp. 893.
35. Podzolkov V.P., Alimbaev S.A. Radikalnaya korrekciya tetrady Fallo posle ranee vy’polnennogo anastomoza po Bleloku-Taussig [Radical correction of the Fallot tetrad after a previously performed Blelock-Taussig anastomosis]. Grudnaya i serdechno-sosudistaya hirurgiya, 1991, no. 1, pp. 25-28. (in Russian).
36. Potapov E.V., Alexi-Meskishili V.V., Dahnert I., Lange P.E., Hetzer R. Development of pulmonary arteries after central aortopulmonary shunt in newborns. Ann Thorac Surg, 2001, vol. 71, pp. 899-905.
37. Tchervenkov C.I., Pelletler M.P., Shum-Tim D., Beland M.J., Rohllcek C. Primary repair minimizing the use of conduits and infants with tetralogy or Double-outlet right ventricle and anomalous coronary arteries. J Thorac Cardiothorac Surg, 2000, vol. 119, pp. 314-323.
38. Kiran U., Aggarwal S., Choudhary A., Uma B., Kapoor P.M. The blalock and taussig shunt revisited. Ann Card Anaesth, 2017, vol. 20, no. 3, pp. 323-330. doi: 10.4103/aca.ACA_80_17.
39. McKenzie E.D., Khan M.S., Samayoa A.X., Ishak Y.M., Santos A.B., Heinle J.S., Fraser Jr.C.D. The Blalock-Taussig shunt revisited: A contemporary experience. J Am Coll Surg, 2013, vol. 216, no. 4, pp. 699-704. doi: 10.1016/j.jamcollsurg.2012.12.027.
40. Chernoglaz P.F., Linnik Yu.I., Bashkevich A.V., Chernoglaz P.F., Linnik Yu.I., Bashkevich A.V., Korolkova E.V., Savchuk A.I., Shevchenko N.S., Drozdovskiy K.V. Preimus-ch’estva stentirovaniya vyhodnogo otdela pravogo jeludochka v sravnenii s nalojeniem modificirovannogo anastomoza po blelok-Tausig pered provdeniem radikal’noy korrekcii tetrady’ Fallo u detey [Advantages of stenting of the right ventricular outlet in comparison with applying a modified blelock-Tausig anastomosis before performing a radical correction of the Fallot tetrad in children]. Neotlojnaya kardiologiya i kardiovaskulyarny’e riski, 2019, vol. 3, no. 1, pp. 532-538. (in Russian).
41. Alwi M. Stenting the ductus arteriosus: Case selection, technique and possible complications. Ann Pediatr Cardiol, 2008, vol. 1, no. 1, pp. 38-45. doi: 10.4103/0974-2069.41054.
42. Bentham J.R., Zava N.K., Harrison W.J., Shauq A., Kalantre A., Derrick G., Chen R.H., Dhillon R., Taliotis D., Kang S.-L., Crossland D., Adesokan A., Hermuzi A., Kudumula V., Yong S., Noonan P., Hayes N., Stumper O., Thomson J.D.R. Duct Stenting Versus Modified Blalock-Taussig Shunt in Neonates With Duct-Dependent Pulmonary Blood Flow: Associations With Clinical Outcomes in a Multicenter National Study. Circulation, 2018, vol. 137, no. 6, pp. 581-588. doi: 10.1161/CIRCULATIONAHA.117.028972.
43. Glatz A.C., Petit C.J., Goldstein B.H., Kelleman M.S., McCracken C.E., McDonnell A., Buckey T., Mascio C.E., Shashidharan S., Ligon R.A., Ao J., Whiteside W., Wallen W.J., Metcalf C.M., Aggarwal V., Agrawal H., Qureshi A.M. Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow: Insights From the Congenital Catheterization Research Collaborative. Circulation, 2018, vol. 137, no. 6, pp. 589-601. doi: 10.1161/CIRCULATIONAHA.117.029987.
44. Chernoglaz P.F., Linnik Yu.I., Bashkevich A.V., Korol’kova E.V., Savchuk A.I., Shevchenko N.S., Drozdovskiy K.V. Stentirovanie vyhodnogo otdela pravogo jeludochka kak e`tapnoe palliativnoe vmeshatel’stvo pered provedeniem radikal’noy korrekcii tetrady’ Fallo u detey [Stenosis of the right ventricular outlet as a step-by-step palliative intervention before radical correction of the Fallot tetrad in children]. Neotlojnaya kardiologiya i kardiovaskulyarnye riski, 2018, vol. 2, no 1, pp. 230-236. (in Russian).
45. Laudito A., Bandisode V.M., Lucas J.F., Radtke W.A., Adamson W.T., Bradley S.M. Right Ventricular Outflow Tract Stent as a Bridge to Surgery in a Premature Infant with Tetralogy of Fallot. Ann Thorac Surg, 2006, vol. 81, no. 2, pp. 744-6. doi: 10.1016/j.athoracsur.2004.10.068.
46. Dohlen G., Chaturvedi R.R., Benson L.N., Ozawa A., Van Arsdell G.S., Fruitman D.S., Lee K.-J. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart, 2009, vol. 95, no. 2, pp. 142-147. doi: 10.1136/hrt.2007.135723.
47. Quandt D., Ramchandani B., Penford G., Stickley J., Bhole V., Mehta C., Jones T., Barron D.J. Oliver Stumper Right ventricular outflow tract stent versus BT shunt palliation in Tetralogy of Fallot. Heart, 2017, vol. 102, no. 24, pp. 1985-1991. doi: 10.1136/heartjnl-2016-310620.
48. Quandt D., Ramchandani B., Stickley J., Mehta C., Bhole V., Barron D.J., Stumper O. Stenting of the Right Ventricular Outflow Tract Promotes Better Pulmonary Arterial Growth Compared With Modified Blalock-Taussig Shunt Palliation in Tetralogy of Fallot-Type Lesions. JACC Cardiovasc Interv, 2017, vol. 10, no. 17, pp. 1774-84. 10.1016/j.jcin.2017.06.023.
49. Sandoval J.P. Chaturvedi R.R., Benson L., Morgan G., Van Arsdell G., Honjo O., Caldarone C., Lee K.-J. Right Ventricular Outflow Tract Stenting in Tetralogy of Fallot Infants With Risk Factors for Early Primary Repair. Circ Cardiovasc Interv, 2016, vol. 9, no. 12, pp. e003979. doi: 10.1161/CIRCINTERVENTIONS.116.003979.
50. Chernoglaz P.F., Linnik Yu.I., Bashkevich A.V., Korolkova E.V., Savchuk A.I., Shevchenko N.S., Drozdovskiy K.V. Radikalnaya korrekciya tetrady Fallo u detey posle stentirovaniya vyhodnogo otdela pravogo jeludochka [Radical correction of the Fallot tetrad in children after stenting of the right ventricular outlet]. Neotlojnaya kardiologiya i kardiovaskulyarnye riski, 2019, vol. 3, no. 2, pp.734-738. (in Russian).

Полнотекстовая статья

Скачать статью

Формат файла: pdf (1.39 Мб)

→ Главная → 2021 том 5, №1