Meijboom Folkert J, Roos-Hesselink Jolien W, McGhie Jackie S, Spitaels Silja E C, van Domburg Ron T, Utens Lisbeth M W J, Simoons Maarten L, Bogers Ad J J C
Department of Cardiology, Sophia Children's Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
J Thorac Cardiovasc Surg. 2008 Jan;135(1):50-5. doi: 10.1016/j.jtcvs.2007.07.030.
The aim of the study was to assess the long-term results of a selective policy toward pulmonary valve replacement in adult patients with repaired tetralogy of Fallot and severe pulmonary regurgitation.
Sixty-seven patients with tetralogy of Fallot were followed up from 15 +/- 3 years until 27 +/- 3 years after surgery.
Twenty-two patients had mild-to-moderate pulmonary regurgitation. No significant changes occurred in the follow-up period. Of 45 patients with severe pulmonary regurgitation and severe right ventricular dilatation, 28 (62%) remained free of symptoms and did not undergo pulmonary valve replacement. No changes in right ventricular size or exercise capacity were found. In 3 (11%) of 28 patients, QRS duration increased to more than 180 ms. Seventeen patients had symptoms and underwent pulmonary valve replacement: 9 (54%) of 17 patients improved clinically and echocardiographically, and QRS duration shortened postoperatively. Right ventricular dimensions did not regress despite pulmonary valve replacement in 8 patients.
Refraining from pulmonary valve replacement in asymptomatic patients led to no measurable deterioration in 25 (89%) of 28 patients. Referring symptomatic patients for pulmonary valve replacement led to an improvement in 9 (53%) of 17 patients. In 11 (24%) of 45, a selective approach led to questionable or unsatisfactory results.
本研究旨在评估对法洛四联症修补术后合并严重肺动脉反流的成年患者采取肺动脉瓣置换的选择性策略的长期效果。
67例法洛四联症患者在术后15±3年至27±3年进行随访。
22例患者有轻至中度肺动脉反流。随访期间无显著变化。45例严重肺动脉反流和严重右心室扩张的患者中，28例（62%）无症状，未接受肺动脉瓣置换。右心室大小和运动能力无变化。28例患者中有3例（11%）QRS时限增加至超过180毫秒。17例患者有症状并接受了肺动脉瓣置换：17例患者中有9例（54%）临床和超声心动图表现改善，术后QRS时限缩短。8例患者尽管进行了肺动脉瓣置换，右心室尺寸并未缩小。
28例无症状患者中，25例（89%）不进行肺动脉瓣置换未导致可测量的病情恶化。17例有症状患者进行肺动脉瓣置换后，17例中有9例（53%）病情改善。45例中有11例（24%）采取选择性策略导致结果存疑或不尽人意。
