Cheung Y F, Ou X, Wong S J
Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Grantham Hospital, The University of Hong Kong, Hong Kong, China.
Heart. 2006 Dec;92(12):1827-30. doi: 10.1136/hrt.2006.091199. Epub 2006 Jun 14.
To test the hypotheses that (1) the central conduit arteries stiffen preferentially over the peripheral conduit arteries in patients with repaired tetralogy of Fallot (ToF); and (2) central arterial stiffening is related to aortic root dilatation.
Heart-femoral pulse wave velocity (PWV), femoral-ankle PWV, carotid augmentation index and body surface area-adjusted aortic sinotubular dimension were determined in 31 children after ToF repair and compared with those in 31 age-matched controls after left-to-right shunt repair. In addition, the PWVs and augmentation index were related to the sinotubular junction dimension.
Tertiary paediatric cardiac centre.
Compared with controls, patients had significantly greater heart-femoral PWV (mean 666 (SD 151) v 587 (81) cm/s, p = 0.021) and carotid augmentation index (-14.1 (17.0)% v -25.2 (14.6)%, p = 0.016), whereas the right (888 (202) v 845 (207) cm/s, p = 0.42) and left (918 (227) v 851 (215) cm/s, p = 0.25) femoral-ankle PWVs were similar between the two groups. The sinotubular junction z score of patients was significantly greater than that of controls (4.7 (1.5) v 1.1 (1.4), p < 0.001). Univariate analysis showed that the sinotubular junction z score correlated positively with heart-femoral PWV (r = 0.43, p = 0.001) and carotid augmentation index (r = 0.46, p = 0.001). Multiple linear regression similarly identified heart-femoral PWV (beta = 0.30, p = 0.04) and carotid augmentation index (beta = 0.31, p = 0.04) (model R(2) = 0.26) as significant determinants of sinotubular junction z score.
The aorta stiffens in patients with repaired ToF, which may contribute to progressive dilatation of the aortic root in the long term.
检验以下假设：（1）法洛四联症（ToF）修复术后患者的中心传导动脉比外周传导动脉更易发生僵硬；（2）中心动脉僵硬与主动脉根部扩张有关。
测定了31例ToF修复术后儿童的心脏-股动脉脉搏波速度（PWV）、股-踝PWV、颈动脉增强指数和体表面积校正后的主动脉窦管交界尺寸，并与31例年龄匹配的左向右分流修复术后对照者进行比较。此外，PWV和增强指数与窦管交界尺寸相关。
三级儿科心脏中心。
与对照组相比，患者的心脏-股动脉PWV显著更高（平均666（标准差151）对587（81）cm/s，p = 0.021），颈动脉增强指数更低（-14.1（17.0）%对-25.2（14.6）%，p = 0.016），而两组的右侧（888（202）对845（207）cm/s，p = 0.42）和左侧（918（227）对851（215）cm/s，p = 0.25）股-踝PWV相似。患者的窦管交界z评分显著高于对照组（4.7（1.5）对1.1（1.4），p < 0.001）。单因素分析显示，窦管交界z评分与心脏-股动脉PWV（r = 0.43，p = 0.001）和颈动脉增强指数（r = 0.46，p = 0.001）呈正相关。多元线性回归同样确定心脏-股动脉PWV（β = 0.30，p = 0.04）和颈动脉增强指数（β = 0.31，p = 0.04）（模型R² = 0.26）是窦管交界z评分的重要决定因素。
ToF修复术后患者的主动脉发生僵硬，这可能长期导致主动脉根部逐渐扩张。
