Grotenhuis H B, Ottenkamp J, de Bruijn L, Westenberg J J M, Vliegen H W, Kroft L J M, de Roos A
Department of Radiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
Heart. 2009 Dec;95(23):1931-6. doi: 10.1136/hrt.2009.175877. Epub 2009 Aug 25.
Aortic wall pathology and concomitant aortic dilatation have been described in tetralogy of Fallot (TOF) patients, which may negatively affect aortic valve and left ventricular systolic function.
To assess aortic dimensions, aortic elasticity, aortic valve competence and biventricular function in repaired TOF patients after pulmonary valve replacement (PVR) using magnetic resonance imaging (MRI).
MRI was performed in 16 patients with TOF after PVR (10 male; mean age 31 years (SD 15)) and 16 age and gender-matched healthy subjects.
TOF patients showed aortic root dilatation (mean difference 7.8-8.8 mm, p<0.01 at all four predefined levels) and reduced aortic elasticity (pulse wave velocity in aortic arch 5.5 m/s (1.2) vs 4.6 m/s (0.9), p = 0.04; aortic root distensibility 1.4/10(-3) mm Hg (1.7) vs 5.7/10(-3) mm Hg (3.6), p<0.01). Minor degrees of aortic regurgitation (AR) (AR fraction 6% (8) vs 1% (1), p<0.01) and reduced left ventricular ejection fraction (LVEF) were present (51% (8) vs 58% (6), p = 0.01), whereas right ventricular ejection fraction (RVEF) was within normal limits (47% (8) vs 52% (7), p = 0.06). The degree of AR fraction was associated with dilatation of the aortic root (r = 0.39-0.49, p<0.05) and reduced aortic root distensibility (r = 0.44, p = 0.02), whereas reduced LVEF was correlated with degree of AR and RVEF (r = 0.41, p = 0.02 and r = 0.49, p<0.01, respectively).
Aortic root dilatation and reduced aortic elasticity are frequently present in patients with TOF, in addition to minor degrees of AR and reduced left ventricular systolic function. Aortic wall pathology in repaired TOF patients may therefore represent a separate mechanism leading to left ventricular dysfunction, as part of a multifactorial process of left ventricular dysfunction.
法洛四联症（TOF）患者存在主动脉壁病变及主动脉扩张，这可能对主动脉瓣及左心室收缩功能产生负面影响。
采用磁共振成像（MRI）评估肺动脉瓣置换（PVR）术后TOF患者的主动脉尺寸、主动脉弹性、主动脉瓣功能及双心室功能。
对16例PVR术后TOF患者（10例男性；平均年龄31岁（标准差15岁））及16例年龄和性别匹配的健康受试者进行MRI检查。
TOF患者表现出主动脉根部扩张（在所有四个预定义水平上，平均差异为7.8 - 8.8 mm，p<0.01）及主动脉弹性降低（主动脉弓脉搏波速度5.5 m/s（1.2）对比4.6 m/s（0.9），p = 0.04；主动脉根部扩张性1.4/10⁻³ mmHg（1.7）对比5.7/10⁻³ mmHg（3.6），p<0.01）。存在轻度主动脉瓣反流（AR）（AR分数6%（8）对比1%（1），p<0.01）及左心室射血分数（LVEF）降低（51%（8）对比58%（6），p = 0.01），而右心室射血分数（RVEF）在正常范围内（47%（8）对比52%（7），p = 0.06）。AR分数程度与主动脉根部扩张（r = 0.39 - 0.49，p<0.05）及主动脉根部扩张性降低（r = 0.44，p = 0.02）相关，而LVEF降低与AR程度及RVEF相关（分别为r = 0.41，p = 0.02和r = 0.49，p<0.01）。
TOF患者除存在轻度AR及左心室收缩功能降低外，还常出现主动脉根部扩张及主动脉弹性降低。因此，修复后TOF患者的主动脉壁病变可能是导致左心室功能障碍的一个独立机制，是左心室功能障碍多因素过程的一部分。
