Choi Jae Young, Kwon Hae Sik, Yoo Byung Won, Shin Jae Il, Sul Jun Hee, Park Han Ki, Park Young Hwan
Division of Pediatric Cardiology, Cardiovascular Center, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, 120-752, C.P.O. Box 8044, Seoul, Republic of Korea.
Int J Cardiol. 2008 Mar 28;125(1):28-35. doi: 10.1016/j.ijcard.2007.02.020. Epub 2007 Apr 12.
Long-term outcomes of patients with repaired tetralogy of Fallot (TOF) are known to be related with right ventricular (RV) volume overload, severity of pulmonary insufficiency (PI) and the type of outflow repair. Right ventricular restrictive physiology (RVRP) has also been reported to interfere with several factors influencing the late result in repaired TOF patients. However, the mechanism and physiology of this unique myocardial property in the chronically overloaded right ventricle are not yet clearly understood.
We investigated 43 patients after repair of TOF to assess the relationships among biventricular diastolic function, volume characteristics, and influence of respiratory effort. The patients were classified into 3 groups; 15 patients with RVRP and significant PI (RP group, 35%), 19 without RVRP in the presence of significant PI (NR+PI group, 44%), and 9 without RP or significant PI (NR-PI group, 21%). Doppler spectrals obtained by echocardiography from systemic and pulmonary veins, main pulmonary artery (MPA), and both ventricular inlets, and biventricular diastolic function were compared according to the respiratory cycle.
The RP group revealed higher pulmonary venous systolic/diastolic flow ratio (S/D ratio) and the NR+PI group showed larger velocity-time integral (VTI) ratio of total regurgitant/antegrade flow at the MPA and more respiratory variability in the systemic vein.
RP is associated with less volume overload of the RV and smaller respiratory variability is also associated with the restrictive RV. The diastolic function and volume status of the RV may influence the diastolic properties of the left heart.
法洛四联症（TOF）修复术后患者的长期预后已知与右心室（RV）容量超负荷、肺动脉瓣关闭不全（PI）的严重程度以及流出道修复类型有关。右心室限制性生理（RVRP）也被报道会干扰影响TOF修复术后患者晚期结果的几个因素。然而，这种慢性超负荷右心室中这种独特心肌特性的机制和生理学尚未完全清楚。
我们调查了43例TOF修复术后患者，以评估双心室舒张功能、容量特征以及呼吸努力的影响之间的关系。患者被分为3组；15例有RVRP和显著PI的患者（RP组，35%），19例无RVRP但存在显著PI的患者（NR+PI组，44%），以及9例无RP或显著PI的患者（NR-PI组，21%）。根据呼吸周期比较通过超声心动图从体静脉和肺静脉、主肺动脉（MPA）以及两个心室入口获得的多普勒频谱，以及双心室舒张功能。
RP组显示肺静脉收缩期/舒张期血流比值（S/D比值）较高，NR+PI组在MPA处显示总反流/前向血流的速度时间积分（VTI）比值较大，且体静脉的呼吸变异性更大。
RP与RV容量超负荷较轻相关，较小的呼吸变异性也与限制性RV相关。RV的舒张功能和容量状态可能会影响左心的舒张特性。
