Abd El Rahman Mohamed Y, Hui Wei, Yigitbasi Moustafa, Dsebissowa Fatima, Schubert Stephan, Hetzer Roland, Lange Peter E, Abdul-Khaliq Hashim
Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany.
J Am Coll Cardiol. 2005 Mar 15;45(6):915-21. doi: 10.1016/j.jacc.2004.11.049.
We aimed to investigate whether patients after tetralogy of Fallot (TOF) repair with right bundle branch block have left ventricular (LV) asynchrony and to assess the influence of ventricular asynchrony on regional and global LV function.
Patients after TOF repair usually have right bundle branch block. However, no data regarding LV asynchrony in this group are available.
Twenty-five patients after TOF repair and 25 age-matched healthy control subjects were studied. The regional myocardial deformation of the interventricular septum (IVS) and the LV lateral wall were examined using tissue-Doppler-derived strain. The time interval between the onset of QRS complex and the peak strain was measured for each wall. According to the difference between LV and septum time intervals among the normal subjects, a normal range (mean +/- 2 SD) was plotted, and TOF patients in whom the difference was beyond the normal range were considered to have LV asynchrony. The Tei index was used to assess global LV function.
Thirteen (52%) of the examined patients after TOF repair had LV asynchrony. Patients after TOF repair with LV asynchrony had a significantly reduced regional septal systolic strain (p < 0.001) and significantly elevated Tei index (p < 0.001) compared with those without.
Left ventricular asynchrony may exist in patients after TOF repair with right bundle branch block. This LV asynchrony is associated with a reduction of both regional and global LV function.
我们旨在研究法洛四联症（TOF）修复术后合并右束支传导阻滞的患者是否存在左心室（LV）不同步，并评估心室不同步对左心室局部和整体功能的影响。
TOF修复术后的患者通常存在右束支传导阻滞。然而，关于该组患者左心室不同步的数据尚无可用。
对25例TOF修复术后患者和25例年龄匹配的健康对照者进行研究。使用组织多普勒衍生应变检查室间隔（IVS）和左心室侧壁的局部心肌变形。测量每个壁从QRS波群起始到峰值应变的时间间隔。根据正常受试者左心室和室间隔时间间隔的差异绘制正常范围（平均值±2标准差），差异超出正常范围的TOF患者被认为存在左心室不同步。使用Tei指数评估左心室整体功能。
25例接受检查的TOF修复术后患者中有13例（52%）存在左心室不同步。与无左心室不同步的患者相比，存在左心室不同步的TOF修复术后患者的室间隔局部收缩期应变显著降低（p<0.001），Tei指数显著升高（p<0.001）。
TOF修复术后合并右束支传导阻滞的患者可能存在左心室不同步。这种左心室不同步与左心室局部和整体功能的降低有关。
