van Straten Alexander, Vliegen Hubert W, Hazekamp Mark G, Bax Jeroen J, Schoof Paul H, Ottenkamp Jaap, van der Wall Ernst E, de Roos Albert
Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Radiology. 2004 Dec;233(3):824-9. doi: 10.1148/radiol.2333030804.
To assess the time course of right ventricular (RV) function improvement after pulmonary valve replacement (PVR) in patients 25.2 years +/- 7.0 after repair of tetralogy of Fallot.
The medical ethics committee approved this study, and informed consent was obtained. Cardiac magnetic resonance (MR) imaging was performed before, 7 months after, and 19 months after PVR in 25 consecutive patients with tetralogy of Fallot with a 1.5-T MR imager. RV function was assessed with gradient-echo sequences in the short-axis plane. Pulmonary flow was assessed with a velocity-encoded phase-contrast sequence. Paired t test was used to evaluate follow-up data. Independent samples t test was used to assess differences based on the presence of recurrent pulmonary regurgitation (PR).
Mean indexed RV end-diastolic volume decreased from 166.9 mL/m(2) +/- 41.3 before PVR to 113.5 mL/m(2)+/- 35.7 (P < .001) at 7-month follow-up and 111.7 mL/m(2)+/- 41.1 (P = .46) at 19-month follow-up. The RV ejection fraction was corrected for PR and improved from 25.0% +/- 7.7 before surgery to 44.1% +/- 11.9 (P < .001) and 45.2% +/- 11.1 (P = .39), at 7- and 19-month follow-up, respectively. Recurrent PR after PVR was found in 11 patients; 14 patients did not have recurrent PR. Total reduction of indexed RV end-diastolic volume at 19 months follow-up was more prominent in patients who did not have recurrent PR than in patients who did have recurrent PR (P < .05). Furthermore, improvement of RV ejection fraction corrected for regurgitation was more marked in patients who did not have recurrent PR than in patients who did have recurrent PR (P < .05).
In patients with tetralogy of Fallot, RV function improves rapidly after PVR and is sustained at 19-month follow-up in most patients; however, recurrence of PR after PVR appears to reduce recovery of RV systolic function.
评估法洛四联症修复术后25.2岁±7.0岁患者行肺动脉瓣置换术（PVR）后右心室（RV）功能改善的时间进程。
本研究经医学伦理委员会批准，并获得了知情同意。对25例连续的法洛四联症患者，使用1.5-T磁共振成像仪在PVR术前、术后7个月和术后19个月进行心脏磁共振（MR）成像。在短轴平面使用梯度回波序列评估RV功能。使用速度编码相位对比序列评估肺血流量。采用配对t检验评估随访数据。采用独立样本t检验评估基于复发性肺动脉反流（PR）的差异。
平均右心室舒张末期容积指数从PVR术前的166.9 mL/m²±41.3降至术后7个月随访时的113.5 mL/m²±35.7（P <.001），以及术后19个月随访时的111.7 mL/m²±41.1（P =.46）。RV射血分数经PR校正后，从术前的25.0%±7.7提高到术后7个月随访时的44.1%±11.9（P <.001）和术后19个月随访时的45.2%±11.1（P =.39）。PVR术后发现11例患者有复发性PR；14例患者无复发性PR。术后19个月随访时，无复发性PR的患者右心室舒张末期容积指数的总减少量比有复发性PR的患者更显著（P <.05）。此外，无复发性PR患者经反流校正后的RV射血分数改善比有复发性PR的患者更明显（P <.05）。
法洛四联症患者行PVR后，RV功能迅速改善，且在大多数患者术后19个月随访时得以维持；然而，PVR术后PR的复发似乎会降低RV收缩功能的恢复。
