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Volume 1, ¹4



Art of Medicine
International Medical Scientific journal

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ART of MEDICINE

International Medical Scientific
Journal

Volume 1, ¹4 December 2021



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Volume 1, ¹4

Art of Medicine
International Medical Scientific journal

Founder and Publisher Pascual Izquierdo-Egea
Published science may 2021 year. Issued Quarterly.
Internet address: http://artofmedicineimsj.us
E-mail: info@artofmedicineimsj.us
11931 Barlow Pl  Philadelphia, PA 19116, USA

CHIEF EDITOR

Dr. Pascual Izquierdo-Egea

EDITORIAL BOARD

Prof. Dr. Francesco Albano

Dr. Catherine J. Andersen

Prof. Dr. Sandro Ardizzone

Dr. Dmitriy Atochin

Prof. Dr. Antonio Aversa

Prof. Dr. Tamam Bakchoul

Prof. Dr. Pierre-Gregoire Guinot

Prof. Dr. Rainer Haak

Prof. Henner Hanssen



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Volume 1, ¹4

CLINICAL AND INSTRUMENTAL PECULIARITIES OF THE
POSTOPERATIVE PERIOD IN CHILDREN WITH TETRALOGY OF FALLOT

Akhmedova N.R., Matkarimova A.A.,  Kazakbaeva T.T., Seitbaeva A.M.
Republican children's multidisciplinary medical center,  Nukus city

Tashkent Pediatric Medical Institute
Karakalpak Medical Institute

Abstract.The article presents the results of an examination of 20 patients with tetralogy
of Fallot who underwent surgery for the correction of the defect. The research results showed
that in children with TF, the postoperative period proceeds with various complications, the
course of which directly depends on the severity of the defect, the volume, complexity,
duration of surgery, as well as the presence of concomitant diseases in the form of hypoxic-
ischemic encephalopathy and eating disorders.

Key words: Òetralogy of Fallot, postoperative complications, course features

Relevance.  (TOF) is diagnosed in 8-13% of all patients with congenital heart disease
[1,3]. Among malformations requiring surgical treatment in early childhood, Fallo's
tetrad (FT) accounts for 15%. The incidence in newborns varies from 4% to 7%. The
average life expectancy of patients with FT is 12-13 years and depends on the degree of
pulmonary artery stenosis. Mortality during the first year of life is 25%, by the age of 3
years - 40%, by the age of 10 years -70%. Typically, severe unoperated patients die from
thromboembolism in the brain vessels with the formation of abscesses, heart failure and
infectious endocarditis. Considering the current results on elimination of this malformation,
the majority of patients will undergo surgery and reach adulthood [1, 2, 6, 9].

Despite significant achievements of cardiovascular surgery in the radical correction
of FT, the issues of studying the development of postoperative complications and the
development of rehabilitation methods for these children still remain relevant, since the
prevention of complications after successfully performed FT correction directly depends
on the immunity status, the presence of concomitant diseases and the quality of care for
these patients [4, 5, 8].

Based on the above, the study of the peculiarities of the postoperative period course
in children with FT is urgent.

Objective: to study clinical and instrumental peculiarities of the course of postoperative
period in children with FT.

Materials and methods.
We examined 20 patients with FT hospitalized in the department of

cardiorheumatology and cardiosurgery at the clinic of Tashkent pediatric medical institute,
Republican Children's Multidisciplinary Medical Center  in the postoperative period.
All patients underwent clinical-anamnestic, laboratory and instrumental investigations
(chest X-ray, ECG and Echo).

Results of the study.
Analysis of the findings showed that the postoperative period in children with FT is

characterized by the presence of various complications.
The chief complaints on admission were fever (25%), shortness of breath (95%),

cough (95%),  lividity of lips and fingertips weakness (95%),  lethargy (95%), restlessness
(95%), and rapid fatigue (100%). Dyspnea-cyanotic attacks occurred more frequently in
children with a history of birth trauma or with a hypertensive-hydrocephalic syndrome
and were characterized by an abrupt worsening of condition with forced positioning.



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International Medical Scientific journal

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The study of the obstetric history of the mothers of children with TF showed that most
children were born from 1-2 pregnancies (90%). The course of pregnancy in 95% of the
mothers was aggravated by pre-eclampsia and anemia of varying severity. Most of the
women had a respiratory viral infection (65%). 75% of children with TF were born
asphyxiated.

The severity of clinical manifestations of the malformation depended on the pre-
morbid background of the child. According to our data, 40% of children with FT
showed hypoxic-ischemic encephalopathy in the form of hypertension syndrome,
hyperexcitability syndrome, seizure and hydrocephalus syndromes.  70% of children
suffered from grade I-II anemia. From the first days of life, children suffered from
malnutrition and retarded physical development (45%).

The study of anamnestic data of children revealed a high percentage of morbidity in
children. Thus, by the time of surgical correction, almost all children with FT had
frequent recurrent respiratory diseases in the form of VRI, bronchitis, and pneumonia,
which allowed us to classify them as frequently ill children.

Clinically, all patients had a typical picture of malformation manifested as cyanosis,
intensifying with crying and child restlessness (75%), dyspnea (95%), tachycardia (45%),
widening of the borders of relative cardiac dullness. Frequent symptoms of malformation
in older children were thickening and changes in the shape of "watch glasses" nails and
"drumstick" nail phalanges (85%), chest deformity in 25% of children (heart hump). The
severity of the condition was due to frequent respiratory infections, retarded physical
development and phenomena of heart failure.

Percussionly, in children with FT the boundaries of relative cardiac dullness were
dilated on both sides, more to the right, the apical thrust was intensified and pervasive.
Systolic tremor was palpated in the 3rd-4th intercostal space. On auscultation in children
with FT a coarse systolic murmur was heard over the heart area with maximum in 3-4
intercostal space on the left side of the sternum, weakening of II tone over the pulmonary
artery.

The electrocardiogram recorded pronounced tachycardia, signs of right ventricular
hypertrophy (75%), both ventricles (25%), metabolic changes of myocardium.

The radiological picture was characterized by cardiomegaly, due to enlargement of
the right ventricle. Other radiological signs were pulmonary artery retreatment and
impoverishment of the pulmonary pattern.

Fig.1. Chest radiograph of patient L., 3 years old. Fallo's tetrad. A segment of
the pulmonary artery trunk is sunken. The apex is elevated due to RV hypertrophy.



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Volume 1, ¹4
Echo revealed pulmonary artery stenosis, large VSD, mitral-aortic extension and

rightward displacement of the aorta.
The study of laboratory data showed that leukocytosis and lymphopenia predominated

in blood tests. Almost all children had degree II circulatory disorders (DC).
The course of the postoperative period was characterized by various complications.

They manifested as postoperative pneumonia (20%), postcardiac syndrome (15%), rhythm
disturbances (25%), acute heart failure (5%) and bacterial endocarditis (5%) (Fig. 2).

Fig.2.Structure of postoperative complications in children with FT.

According to ECG monitoring in the postoperative period, ventricular arrhythmias
occurred in children with Fallo's Tetrada, which accounted for 60% of all rhythm
disturbances. Atrial rhythm disturbances were registered in 20% of cases and AV nodal
tachycardia in 25% of cases. Echo revealed the following changes: right heart dilatation.

The occurrence of these complications depended on the nature as well as the
extensiveness, duration of surgical intervention, premorbid background of the body and
age of children. The occurrence of pneumonia and postcardiac syndrome in this period
is also facilitated by complications directly related and caused by the surgical trauma
itself.

Fig.3. Ellectrocardiogram of child K., 13 years old. Fallot's tetrad.  Accelerated
AB rhythm HR - 100 bpm. Normal EOS. Complete blockade of the right Giss

bundle leg. Left ventricular extrasystole. hypertrophy of both ventricles.



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International Medical Scientific journal

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Clinical manifestations were characterized by increased body temperature and worsened
physical findings (percussion sound blunting, moist rales with crepitations. According to
literature data, impaired drainage function of bronchi creating favorable conditions for
infection development, congestion in pulmonary artery system, decreased immune
protective forces of the organism are of great importance for pneumonia development in
postoperative period.

Conclusions. Thus, in children with TF the postoperative period proceeds with
various complications, the course of which depends directly on the severity of the
defect, the volume, complexity, duration of surgical intervention, as well as the presence
of concomitant diseases such as hypoxic-ischemic encephalopathy and feeding disorders.



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Used literature.
1.Bokeria L.A. Morbidity and congenital circulatory system defects in children

(prevalence and correction)/L.A. Bokeria, I.N. Stupakov, R.G. Gudkova // Pediatric
Heart and Vascular Diseases.-2016.-#1.- P.Z-10.

2.Cardiac rhythm disturbances during surgical correction of acquired heart defects in
artificial circulation / V.V. Plechev, I.A. Nagaev, N.G. Sibagatullin et al // Health Care
of Bashkortostan,-2016.-#1.-P.82-84.

3.Predictors of rhythm disturbances in young children in the early period after
surgery for radical correction of Fallo's tetrad / LI.A. Bokeria, E.Z. Golukhova, A.I.
Kim et al. // Annals of Arrhythmology.-2016.-#5.-P.66-73.

4.Cherepenin L.P., Ivanov A.S., Buravikhina T.A., Baloyan G.M., Kudryashov
V.E., Kulagina T.I., Dobrovolskaya T.N. Results of radical correction of tetradaFallo in
patients over 16 years // Chest and heart-vascular surgery. -2014.-#2.-P. 15-19.

5.Prilepko L.P. Physical development of patients with Fallo's tetrad // Med. aid.-
2012.-Sh.-P.40-45.

6.Nikitin Ye.S., Tskhovrebov S.V., Zatevakhina M.V., Makrumin KM, Suvorova
G.Yu., Safonova E.M. Mechanical properties of lungs in patients with Fallo tetrad after
radical correction of malformation // Chest and Heart and Vascular Surgery. -2017.-
#1.-P.27-30.

7.Weissman,C.Pulmonary complication after cardiac surgery./C.Weissman// Sem.
In Cardiathorac. And Vasc. Anesth. - 2018. Vol. 8, N3-P.185-211.


