Department of Pediatric Cardiology, International Medical Center, Saitama Medical University Hospital, Hidaka, Saitama, Japan.
Eur J Cardiothorac Surg. 2012 Mar;41(3):570-3. doi: 10.1093/ejcts/ezr032.
Recent studies have linked abnormal aortic medial pathology to progressive aortic root dilatation in patients with tetralogy of Fallot (TOF). To explore whether the aortic medial pathology in TOF is linked to aortic mechanical property, the present study tested the hypothesis that the distribution of impaired aortic elasticity corresponds to the known distribution of abnormal medial pathology (confined to the ascending aorta) in TOF.
Pulse wave velocity (PWV) of the proximal and distal aortas was measured with a high-fidelity micromanometer in 98 TOF patients (64 with repaired TOF and 34 with unrepaired TOF) and 63 control subjects.
PWV of the proximal aorta was significantly higher in TOF than in the control, but similar in repaired and unrepaired TOF (repaired: 588 ± 205 cm/s, unrepaired: 680 ± 288 cm/s, control: 439 ± 101 cm/s, P < 0.001 for each TOF group vs. control, P = 0.07 for repaired vs. unrepaired TOF). In contrast, PWV of the distal aorta was almost identical among the three groups (repaired: 441 ± 189 cm/s, unrepaired: 430 ± 114 cm/s, control: 461 ± 164 cm/s, P = 0.73, analysis of variance), indicating that abnormal aortic mechanical property is confined to the proximal aorta regardless of the operative status of TOF. This was also confirmed by comparison within the group; PWV of the proximal aorta was significantly higher than that of the distal aorta in both TOF groups (P < 0.001, each), whereas there was no difference in PWV between the proximal and distal aortas in the control subjects (P = 0.61).
Consistent with the known histopathological disparity between the media of the ascending and descending aortas, aortic stiffness is markedly increased in the proximal but not in the distal aorta of TOF. These results suggest that aortic wall stiffness is a potentially useful clinical marker of aortic dilation in patients with TOF.
最近的研究将主动脉中层病理学与法洛四联症（TOF）患者的进行性主动脉根部扩张联系起来。为了探讨 TOF 中的主动脉中层病理学是否与主动脉力学特性有关，本研究检验了这样一个假设，即受损的主动脉弹性分布与 TOF 中已知的异常中层病理学分布（仅限于升主动脉）相对应。
使用高保真微压力计测量 98 例 TOF 患者（64 例修复的 TOF 和 34 例未修复的 TOF）和 63 例对照者的近端和远端主动脉脉搏波速度（PWV）。
TOF 患者的近端主动脉 PWV 明显高于对照组，但修复组和未修复组之间无差异（修复组：588±205cm/s，未修复组：680±288cm/s，对照组：439±101cm/s，每个 TOF 组与对照组比较 P<0.001，修复组与未修复组比较 P=0.07）。相反，三组之间的远端主动脉 PWV 几乎相同（修复组：441±189cm/s，未修复组：430±114cm/s，对照组：461±164cm/s，P=0.73，方差分析），表明无论 TOF 的手术状态如何，异常的主动脉力学特性仅局限于近端主动脉。这在组内比较中也得到了证实；TOF 两组的近端主动脉 PWV 均明显高于远端主动脉（均 P<0.001），而对照组近端和远端主动脉的 PWV 无差异（P=0.61）。
与升主动脉和降主动脉之间已知的组织病理学差异一致，TOF 的近端主动脉僵硬度明显增加，但远端主动脉没有增加。这些结果表明，主动脉壁僵硬度可能是 TOF 患者主动脉扩张的一个有用的临床标志物。
