Davlouros Periklis A, Kilner Philip J, Hornung Tim S, Li Wei, Francis Jane M, Moon James C C, Smith Gillian C, Tat Tri, Pennell Dudley J, Gatzoulis Michael A
Department of Cardiology, Royal Brompton Hospital, London, United Kingdom.
J Am Coll Cardiol. 2002 Dec 4;40(11):2044-52. doi: 10.1016/s0735-1097(02)02566-4.
We examined the relationship among biventricular hemodynamics, pulmonary regurgitant fraction (PRF), right ventricular outflow tract (RVOT) aneurysm or akinesia, and baseline and surgical characteristics in adults with repaired tetralogy of Fallot (rTOF).
The precise relationship of pulmonary regurgitation with biventricular hemodynamics has been hampered by limitations of right ventricular (RV) imaging.
We assessed 85 consecutive adults with rTOF and 26 matched healthy controls using cardiovascular magnetic resonance imaging.
Patients had higher right ventricular end-diastolic volume index (RVEDVi) (p < 0.001), right ventricular end-systolic volume index (RVESVi) (p < 0.001), right ventricular mass index (RVMi) (p < 0.001), and lower right ventricular ejection fraction (RVEF) (p < 0.001) and left ventricular ejection fraction (LVEF) (p = 0.002) compared to controls. The PRF (range 0% to 55%) independently predicted RVEDVi (p < 0.01) and the latter predicted RVESVi (p < 0.01) and RVMi (p < 0.01). The RVOT aneurysm/akinesia was present in 48/85 (56.9%) of patients and predicted RV volumes (RVEDVi, p = 0.01, and RVESVi, p = 0.03). There was a negative effect of RVOT aneurysm/akinesia and RVMi on RVEF (p < 0.01 and p = 0.02, respectively). There was only a tendency among patients with transannular or RVOT patching toward RVOT aneurysm/akinesia (p = 0.09). The LVEF correlated with RVEF (r = 0.67, p < 0.001).
Pulmonary regurgitation and RVOT aneurysm/akinesia were independently associated with RV dilation and the latter with RV hypertrophy late after rTOF. The RVOT aneurysm/akinesia was common but related only in part to RVOT or transannular patching. Both RV hypertrophy and RVOT aneurysm/akinesia were associated with lower RVEF. Left ventricular systolic dysfunction correlated with RV dysfunction, suggesting an unfavorable ventricular-ventricular interaction. Measures to maintain or restore pulmonary valve function and avoid RVOT aneurysm/akinesia are mandatory for preserving biventricular function late after rTOF.
我们研究了法洛四联症修复术后（rTOF）成人患者的双心室血流动力学、肺动脉反流分数（PRF）、右心室流出道（RVOT）瘤样扩张或运动减弱与基线及手术特征之间的关系。
右心室（RV）成像的局限性阻碍了肺动脉反流与双心室血流动力学之间精确关系的研究。
我们使用心血管磁共振成像对85例连续的rTOF成人患者和26例匹配的健康对照进行了评估。
与对照组相比，患者的右心室舒张末期容积指数（RVEDVi）更高（p<0.001）、右心室收缩末期容积指数（RVESVi）更高（p<0.001）、右心室质量指数（RVMi）更高（p<0.001），而右心室射血分数（RVEF）更低（p<0.001），左心室射血分数（LVEF）更低（p = 0.002）。PRF（范围为0%至55%）独立预测RVEDVi（p<0.01），而后者又预测RVESVi（p<0.01）和RVMi（p<0.01）。48/85（56.9%）的患者存在RVOT瘤样扩张/运动减弱，且其可预测RV容积（RVEDVi，p = 0.01；RVESVi，p = 0.03）。RVOT瘤样扩张/运动减弱和RVMi对RVEF有负面影响（分别为p<0.01和p = 0.02）。在进行跨环或RVOT修补的患者中，仅存在RVOT瘤样扩张/运动减弱的趋势（p = 0.09）。LVEF与RVEF相关（r = 0.67，p<0.001）。
肺动脉反流和RVOT瘤样扩张/运动减弱与RV扩张独立相关，而后者在rTOF术后晚期与RV肥厚相关。RVOT瘤样扩张/运动减弱很常见，但仅部分与RVOT或跨环修补有关。RV肥厚和RVOT瘤样扩张/运动减弱均与较低的RVEF相关。左心室收缩功能障碍与RV功能障碍相关，提示存在不良的心室间相互作用。对于在rTOF术后晚期维持双心室功能而言，维持或恢复肺动脉瓣功能以及避免RVOT瘤样扩张/运动减弱的措施是必不可少的。
