OBJECTIVETo summarize the experience with surgical correction of tetralogy of Fallot in adults over 40 years of age.

METHODSFrom 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.

RESULTSNineteen 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).

CONCLUSIONSSurgical 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.

Adult ; Female ; Humans ; Male ; Middle Aged ; Tetralogy of Fallot ; surgery ; Treatment Outcome

Objective To explore the establishment and application of specific nursing quality indicators for infectious disease. Methods On the basis of nursing system, nursing criterion, nursing routine and nursing process, the specific nursing quality indicators were established and implemented in our hospital from October 2015 to June 2016. The specific nursing quality indicators were established according to different characteristics of patients, including psychological nursing, isolation protection, high fever nursing and so on. Every indicator was standardized by structure, process and result modules. The 3 modules included 7 items, which is organization management, nursing assessment, measures implementation, shift execution, nursing records, health guidance and related knowledge, and every item was composed of several standard rules. The correct rate of nursing assessment, the rate of measures implementation, the awareness rate of patients′ disease knowledge, the accuracy of nursing record writing, the qualified rate of shift duty, patients′ satisfaction and qualified rate of specific nursing knowledge were compared before and after implementing the specific nursing quality indicators.Results After the implementation of the specific nursing quality indicators, the correct rate of nursing assessment increased from 74. 89% to 89. 33%, the rate of measures implementation increased from 75. 79% to 88.44%, the awareness rate of patients′disease knowledge increased from 65.47% to 79.56%, the accuracy of nursing record writing increased from 65.02% to 88.00%, the qualified rate of shift duty increased from 60.08% to 81.33%, patients′satisfaction increased from 92.06% to 97.08%, the qualified rate of specific nursing knowledge increased from 69. 59% to 86. 49%. Conclusions The establishment and application of specific nursing quality indicators for infectious disease can normalize and standardize nursing work, improve the process quality and final quality of nursing care, help continuous improvement of nursing quality, and ensure the effective implementation of nursing care.