Harikrishnan S, Tharakan J, Titus T, Bhat A, Sivasankaran S, Bimal F, Shyam Sunder K R
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum-11, Kerala, India.
Int J Cardiol. 2000 May 31;73(3):225-30. doi: 10.1016/s0167-5273(00)00219-9.
We reviewed the cine-angiograms of 190 patients with right ventricular outflow tract (RVOT) obstructions for size and anatomy of pulmonary arteries, patent ductus arteriosus (PDA) and major aorto pulmonary collateral arteries (MAPCAs). Patients were grouped into three, Tetralogy of Fallot (TOF) with pulmonary atresia (group 1, N=86), TOF with pulmonary stenosis (group 2, N=97) and 7 cases of pulmonary atresia with intact interventricular septum (group 3). Out of 86 patients in group 1, 49 had PDA alone, 30 had MAPCAs alone, six had both and one had none. In group 2, 31 patients had persistent PDA and one patient had MAPCAS and PDA. A discrete stenosis (DS) of pulmonary artery was seen significantly more in patients with RVOT obstructions associated with PDA compared to patients without PDA (67/84 vs. 5/96). Out of the 84 cases with ducti, 53 had stenosis of the pulmonary artery at the site of ductus insertion. Thus presence of PDA was an important factor in the development of DS. The likely cause of pulmonary artery stenosis in TOF with PDA may be the opposing flows through RVOT and PDA producing a watershed effect at the ductus-pulmonary artery junction. Diffuse hypoplasia of pulmonary arteries (DH) was seen more significantly in RVOT obstructions associated with MAPCAs, compared to other patient groups (19/36 vs. 14/87). These small pulmonary arteries had no discrete stenosis and this diffuse hypoplasia might be the result of inadequate blood flow during intrauterine life [Harikrishnan S, Tharakan J, Titus T, Bhat A, Sivasankaran S, Bimal F, Syam Sunder KR, James, KJ. Central pulmonary artery anatomy in right ventricular outflow tract obstructions. Indian Heart Journal 1997;49:624 (Abstract)[18]].
我们回顾了190例右心室流出道（RVOT）梗阻患者的心血管造影图像，以了解肺动脉的大小和解剖结构、动脉导管未闭（PDA）以及主要的主肺动脉侧支动脉（MAPCAs）情况。患者被分为三组，肺动脉闭锁型法洛四联症（TOF）（第1组，N = 86）、肺动脉狭窄型TOF（第2组，N = 97）以及7例室间隔完整的肺动脉闭锁患者（第3组）。在第1组的86例患者中，49例仅有PDA，30例仅有MAPCAs，6例两者皆有，1例两者皆无。在第2组中，31例患者存在持续性PDA，1例患者有MAPCAs和PDA。与无PDA的患者相比，伴有PDA的RVOT梗阻患者中肺动脉离散性狭窄（DS）的发生率显著更高（67/84 vs. 5/96）。在84例有动脉导管的病例中，53例在动脉导管插入部位存在肺动脉狭窄。因此，PDA的存在是DS发生的一个重要因素。伴有PDA的TOF中肺动脉狭窄的可能原因可能是通过RVOT和PDA的反向血流在动脉导管 - 肺动脉交界处产生了分水岭效应。与其他患者组相比，伴有MAPCAs的RVOT梗阻中肺动脉弥漫性发育不全（DH）更为显著（19/36 vs. 14/87）。这些小肺动脉没有离散性狭窄，这种弥漫性发育不全可能是宫内生活期间血流不足的结果[哈里克里什南S，塔拉坎J，蒂图斯T，巴特A，西瓦桑卡兰S，比马尔F，西亚姆·桑德KR，詹姆斯，KJ。右心室流出道梗阻时中央肺动脉解剖结构。《印度心脏杂志》1997；49：624（摘要）[18]]
