Geva Tal
Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006:11-22. doi: 10.1053/j.pcsu.2006.02.009.
Surgical management of tetralogy of Fallot results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced the dysfunction might be irreversible. In light of that data and with better understanding of risk factors for adverse outcomes late after tetralogy of Fallot repair, many centers are now recommending early pulmonary valve replacement before symptoms of heart failure develop. This article reviews the pathophysiology of chronic right ventricular volume load after tetralogy of Fallot repair and the risks and benefits of pulmonary valve replacement. Finally, recommendations for timing and indications for pulmonary valve replacement are given.
法洛四联症的外科治疗会导致大多数患者出现解剖学和功能上的异常。尽管严重肺反流引起的右心室容量负荷在数年内可被耐受，但现在有证据表明，右心室心肌的代偿机制最终会失效，而且如果容量负荷不消除或减轻，功能障碍可能会不可逆转。鉴于这些数据，并随着对法洛四联症修复术后晚期不良结局危险因素的更好理解，许多中心现在建议在心力衰竭症状出现之前尽早进行肺动脉瓣置换。本文综述了法洛四联症修复术后慢性右心室容量负荷的病理生理学以及肺动脉瓣置换的风险和益处。最后，给出了肺动脉瓣置换的时机和指征建议。
