Abd El Rahman M Y, Abdul-Khaliq H, Vogel M, Alexi-Meskischvili V, Gutberlet M, Hetzer R, Lange P E
Department of Congenital Heart Disease, Deutsches Herzzentrum, Augustenburger Platz 1, D-13353 Berlin, Germany.
Pediatr Cardiol. 2002 Sep-Oct;23(5):502-7. doi: 10.1007/s00246-002-1469-5.
The systolic and diastolic function in both ventricles may be altered even after successful corrective surgery of tetralogy of Fallot. The aim of this study was to assess the combined diastolic and systolic function of both ventricles using the Doppler-derived myocardial performance index (MPI) in patients with operated tetralogy of Fallot (TOF). We performed a prospective analysis of 51 patients following corrective surgery of TOF: 21 had a subannular patch, 20 had a homograft implantation at initial operation, and 10 were reoperated with secondary homograft implantation. Patients were examined with Doppler echocardiography, and the MPI, which incorporates ejection and isovolumetric relaxation and contraction times and is an index of global ventricular function, was calculated 10.2 +/- 8.0 (0.89-36) years after surgery. In 86.4% of the examined patients the right ventricular isovolumetric relaxation time was shortened compared to the normal published range or even did not exist (negative value) (p <0.01). The right ventricular MPI was paradoxically below the normal published range in 76.5% of the examined patients. The left ventricle global function was impaired in 23.5% of the examined patients, mainly due to altered systolic function with a prolonged left ventricular isovolumetric contraction time. The z score of the comparison between patients' left ventricular isovolumetric contraction time and the normal published values was 3.03. Patients with severe pulmonary regurgitation also had a prolongation of the isovolumetric relaxation time compared to patients with mild to moderate pulmonary regurgitation. The noncompliant right ventricle may shorten the right ventricular isovolumetric relaxation time, resulting in a paradoxically low right MPI. This may reduce the sensitivity of the index in recognizing patients with right ventricular dysfunction following corrective surgery of TOF. Additional diastolic impairment occurs in patients with right ventricular volume overload.
即使法洛四联症成功进行矫正手术后，两个心室的收缩和舒张功能仍可能发生改变。本研究的目的是使用多普勒衍生的心肌性能指数（MPI）评估法洛四联症（TOF）手术患者两个心室的舒张和收缩联合功能。我们对51例TOF矫正手术后的患者进行了前瞻性分析：21例患者最初手术时使用了瓣环下补片，20例患者最初手术时进行了同种异体移植植入，10例患者再次手术并进行了二次同种异体移植植入。患者接受了多普勒超声心动图检查，并在术后10.2±8.0（0.89 - 36）年计算了MPI，该指数包含射血时间、等容舒张时间和等容收缩时间，是整体心室功能的指标。在86.4%的受检患者中，右心室等容舒张时间与已发表的正常范围相比缩短，甚至不存在（负值）（p<0.01）。在76.5%的受检患者中，右心室MPI反常地低于已发表的正常范围。23.5%的受检患者左心室整体功能受损，主要是由于收缩功能改变，左心室等容收缩时间延长。患者左心室等容收缩时间与已发表正常数值比较的z评分为3.03。与轻度至中度肺反流患者相比，重度肺反流患者的等容舒张时间也延长。顺应性差的右心室可能会缩短右心室等容舒张时间，导致右MPI反常地低。这可能会降低该指数在识别TOF矫正手术后右心室功能障碍患者时的敏感性。右心室容量超负荷的患者会出现额外的舒张功能损害。
