title: [Surgical correction of tetralogy of Fallot in adults over 40 years of age].
abstract: OBJECTIVE
  To summarize the experience with surgical correction of tetralogy of Fallot in adults over 40 years of age.
  
  
  METHODS
  From November 1985 to July 2008, 9 male and 11 female patients aged 41-53 years (mean 46.3±3.5 years) underwent total surgical correction for tetralogy of Fallot. Twelve patients had preoperative NYHA class III cardiac function. The common comorbidities included infective endocarditis, cerebral abscess, cerebral infarction, renal dysfunction, and tricuspid insufficiency. Surgical corrections were carried out at the anatomical or physiological level.
  
  
  RESULTS
  Nineteen patients received right ventriculotomy to relieve right ventricular outflow obstruction and for ventricular septal defect closure, and 1 patient had Fontan operation. Two patients died after the surgery for heart failure and ventricular fibrillation. The average cardiopulmonary bypass time, aortic clamp time, and postoperative ventilation time was 142.9±36.3 min, 89.9±25.1 min, and 72.0±17.5 h, respectively. Postoperative low cardiac output syndrome occurred in 5 cases, septic shock in 1 case, secondary renal failure in 1 case, and bleeding in 2 cases. Echocardiography showed a significant postoperative reduction of the mean right ventricular outflow tract velocity from 4.29±1.36 m/s to 2.13±0.83 m/s (P<0.01); the right ventricular longitudinal dimension exhibited no significant changes postoperatively (57.1±6.7 mm vs 55.1±7.0 mm, P=0.65).
  
  
  CONCLUSIONS
  Surgical correction of the tetralogy of Fallot in patients over 40 years is highly risky and requires appropriate management of cardiac failure, careful myocardial protection, and thorough intracardiac lesion correction to decrease surgical complications.
authors.affiliation: Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou 510080, China. jianxuhua@tom.com
authors.forename: Xuhua
authors.initials: X
authors.lastname: Jian
authors.forename: Jinsong
authors.initials: J
authors.lastname: Huang
authors.forename: Jian
authors.initials: J
authors.lastname: Zhuang
authors.forename: Ruobin
authors.initials: R
authors.lastname: Wu
authors.forename: Xuejun
authors.initials: X
authors.lastname: Xiao
authors.forename: Shaoyi
authors.initials: S
authors.lastname: Zheng
authors.forename: Min
authors.initials: M
authors.lastname: Wu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome