Van Aerschot Isabelle, Iserin Laurence
Unité des cardiologies congénitales de l'adulte, hôpital européen Georges-Pompidou, centre de référence des malformations congénitales complexes, 75015 Paris, France.
Presse Med. 2011 Jul-Aug;40(7-8):740-7. doi: 10.1016/j.lpm.2011.02.030. Epub 2011 May 14.
Repair of tetralogy of Fallot (TOF) exists for more than 40 years. This repair results in a pulmonary regurgitation, which is usually well tolerated for two decades or so, but eventually this is injurious for the right ventricle (RV). The RV enlargement and severe RV dysfunction increase risk for ventricular tachycardia (VT) and sudden death in the long-term. The pulmonary valve replacement (PVR) is shifting earlier to preserve RV function before patients develop symptoms. Several parameters have to be considered to facilate correct timing for PVR (surgically of by catheterization) : echocardiography, magnetic resonance imaging, electrocardiogram and cardiopulmonary exercise. All patients should have regular follow-up in a specialized grown-up congenital heart disease (GUCH) center to detect as soon as possible pathological signs of RV enlargement. Implantable cardioverter-defibrillator (ICD) implantation for primary prevention and programmed ventricular stimulation in repaired TOF remain controversal.
法洛四联症（TOF）修复术已存在40多年。这种修复会导致肺动脉反流，通常在二十年左右的时间里耐受性良好，但最终这会对右心室（RV）造成损害。长期来看，右心室扩大和严重的右心室功能障碍会增加室性心动过速（VT）和猝死的风险。肺动脉瓣置换术（PVR）正在更早地进行，以在患者出现症状之前保留右心室功能。为了促进肺动脉瓣置换术（通过手术或导管插入术）的正确时机选择，必须考虑几个参数：超声心动图、磁共振成像、心电图和心肺运动。所有患者都应在专门的成人先天性心脏病（GUCH）中心进行定期随访，以便尽快发现右心室扩大的病理迹象。对于法洛四联症修复术后的一级预防植入式心脏复律除颤器（ICD）以及程序性心室刺激仍存在争议。
