Division of Cardiothoracic Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
Hong Kong Med J. 2010 Feb;16(1):26-30.
To evaluate the results of pulmonary valve replacement in patients with severe pulmonary regurgitation after tetralogy of Fallot repair in Hong Kong.
Retrospective review.
University teaching hospital, Hong Kong.
Consecutive patients undergoing pulmonary valve replacement after repair of tetralogy of Fallot between August 2002 and December 2008.
Magnetic resonance imaging of right ventricular volume and cardiopulmonary exercise test data before and after the operation were documented and compared.
Over a 6-year period, 16 patients underwent pulmonary valve replacement for severe pulmonary regurgitation after prior complete repair for tetralogy of Fallot. There was no in-hospital mortality. The mean time interval between the initial repair and pulmonary valve replacement was 19 (standard deviation, 9) years. In three patients, the indication for pulmonary valve replacement was symptomatic severe pulmonary regurgitation, and asymptomatic progressive right ventricular dilatation in the remaining 13 patients. After pulmonary valve replacement, there was a significant decrease in the mean indexed right ventricular end-diastolic volume from 173 (standard deviation, 44) mL/m(2) to 103 (19) mL/m(2) (P=0.043). After the operation, there was also a tendency for improvement of the right ventricular ejection fraction and the maximum oxygen consumption: from 42% (standard deviation, 9%) to 47% (6%) [P=0.173], and 27 (4) mL/kg/min to 29 (4) mL/kg/min (P=0.208), respectively.
Pulmonary valve replacement for severe pulmonary regurgitation after tetralogy of Fallot repair is a safe procedure. However, the indications for such an operation in asymptomatic patients remain controversial. Further studies are required to better delineate the timing of pulmonary valve replacement in this patient group.
评估香港法乐四联症修复术后重度肺动脉瓣反流患者行肺动脉瓣置换术的效果。
回顾性研究。
香港大学教学医院。
2002 年 8 月至 2008 年 12 月期间连续因法乐四联症修复术后出现重度肺动脉瓣反流而行肺动脉瓣置换术的患者。
记录并比较患者手术前后右心室容量的磁共振成像和心肺运动试验数据。
在 6 年期间，16 例患者因法乐四联症初始修复术后出现重度肺动脉瓣反流而行肺动脉瓣置换术，无院内死亡。初次修复与肺动脉瓣置换的平均时间间隔为 19（标准差 9）年。在 3 例患者中，肺动脉瓣置换的指征为有症状的重度肺动脉瓣反流，其余 13 例患者为无症状的右心室进行性扩张。行肺动脉瓣置换术后，平均右心室舒张末期容积指数从 173（标准差 44）mL/m²下降至 103（19）mL/m²（P=0.043）。术后，右心室射血分数和最大耗氧量也有改善趋势：从 42%（标准差 9%）升高至 47%（6%）（P=0.173），从 27（4）mL/kg/min 升高至 29（4）mL/kg/min（P=0.208）。
法乐四联症修复术后重度肺动脉瓣反流患者行肺动脉瓣置换术是安全的，但对于无症状患者行此手术的适应证仍存在争议。需要进一步研究以更好地确定该患者群体行肺动脉瓣置换术的时机。
