Gregg David, Foster Elyse
Adult Congenital Heart Disease Program, Division of Cardiology, Medical University of South Carolina, 135 Rutledge Avenue, Suite 1201, PO Box 250592, Charleston, SC 29425, USA.
Curr Cardiol Rep. 2007 Jul;9(4):315-22. doi: 10.1007/BF02938380.
The number of adults with tetralogy of Fallot now exceeds the number of children with the disorder due to childhood surgical successes. After surgical repair, however, most patients are left with pulmonary regurgitation that, over time, results in right ventricular volume overload, enlargement, and dysfunction. Usually well tolerated for 20 years or more, ongoing pulmonary insufficiency is at the core of late complications that include right ventricular failure, exercise intolerance, atrial and ventricular arrhythmias, and sudden death. Though late pulmonary valve replacement appears to attenuate this risk, prostheses have a finite life span. Thus, the timing of surgery must be carefully considered, weighing the up-front risks of surgery and possible repeat surgery against the risk of ongoing pulmonary regurgitation.
由于儿童期手术的成功，患有法洛四联症的成年人数量现已超过患有该疾病的儿童数量。然而，手术修复后，大多数患者会出现肺动脉反流，随着时间的推移，会导致右心室容量超负荷、扩大和功能障碍。持续的肺动脉瓣关闭不全通常在20年或更长时间内耐受性良好，是包括右心室衰竭、运动不耐受、房性和室性心律失常以及猝死在内的晚期并发症的核心。尽管晚期肺动脉瓣置换术似乎可以降低这种风险，但人工瓣膜的使用寿命有限。因此，必须仔细考虑手术时机，权衡手术的前期风险和可能的再次手术风险与持续肺动脉反流的风险。
