PROPRANOLOL PALLIATION OF TETRALOGY OF FALLOT: EXPERIENCE WITH LONG-TERM DRUG TREATMENT IN PEDIATRIC PATIENTS

[摘要] Propranolol therapy was given to 22 patients with tetralogy of Fallot (1 mg/kg/6 hr orally). In 13 infants (3 to 20 months of age), the medication was used in effort to postpone surgery to a more optimum size. In nine children (2 to 11 years of age), the drug was used while awaiting surgery, or when parents refused the proposed surgery or when surgery was not recommended because of associated defects.Parameters observed during follow-up evaluations included electrocardiograms, chest x-rays, and pH and blood gas determinations. Serum propranolol values were obtained in 15 patients. The acute hemodynamic response to 0.2 mg/kg given intravenously was observed in eight patients at cardiac catheterization. The frequency and severity of hypoxic spells was evaluated utilizing historical information. Eighteen patients were noted to have spells prior to therapy. Propranolol was observed to abolish or to lessen the hypoxic spells in all but one patient. A satisfactory response, without complications, was observed in 17 patients. Refractoriness to propranolol occurred in five patients. Surgery, either by total correction (seven patients) or by shunt operation (five patients) was performed 3 to 27 months after therapy was begun. Postoperative complications attributable to propranolol were not observed. While the mechanism of propranolol action is open to speculation, the success of propranolol therapy in this series leads us to encourage its use for palliation of patient with tetralogy of Fallot, especially in infants.

[学科分类] 儿科学