Şaylan Berna, Çevik Ayhan, Tavlı Vedide
Clinic of Pediatric Cardiology, İzmir Dr. Behçet Uz Pediatrics and Pediatric Surgery Research and Education Hospital, İzmir-Turkey.
Anadolu Kardiyol Derg. 2012 Sep;12(6):490-7. doi: 10.5152/akd.2012.157. Epub 2012 Jun 15.
The present study aims to study the relationship between tissue Doppler echocardiography (TDE) indices of right ventricle and exercise capacity in patients after total correction for tetralogy of Fallot (ToF).
This cross-sectional observational study included 20 patients, after undergoing total correction procedure for ToF diagnosed with mild/moderate pulmonary regurgitation and 30 age-matched healthy children. In the postoperative period, patients were invited to hospital for evaluation of the ventricular functions by 2D, M-mode, Doppler (DE) echocardiography and TDE and exercise testing to evaluate the effort capacity. Statistical analysis was performed using Mann-Whitney U and Chi-square tests, and Pearson correlation analysis.
Compared with the controls; the mitral annular peak systolic flow velocity (Sm) value was significantly lower, while isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT) and myocardial performance index (MPI) values obtained at the tricuspid and mitral (MV) valves were significantly higher (p<0.05 for all) in patients after ToF repair. There was a negative correlation between the exercise period and the total correction age (r=-0.20, p=0.015) and the same negative correlation existed between the exercise period and METS (r=-0.25, p=0.010). MV IVCT with DE and TDE was found to be correlated with METS (r=-0.45, p=0.04). Left ventricular MPI was found to be correlated with maximum heart rate (r=-0.20, p=0.03). By DE, tricuspid valve deceleration time and Sm peak flow velocity with TDE were significantly correlated with METS (r=-0.30, p=0.04; r=-025, p=0.005, respectively). MPI calculated with TDE was correlated with maximum heart rate (r=-0.15, <0.01).
Even if patients, undergone total correction surgery for ToF were asymptomatic or had minimal clinical symptoms, MPI index assessed by pulse wave TDE and exercise testing may allow early diagnosis of right ventricle dysfunction.
本研究旨在探讨法洛四联症（ToF）完全矫正术后患者右心室组织多普勒超声心动图（TDE）指标与运动能力之间的关系。
这项横断面观察性研究纳入了20例接受ToF完全矫正手术且诊断为轻度/中度肺动脉反流的患者以及30例年龄匹配的健康儿童。术后，邀请患者到医院通过二维、M型、多普勒（DE）超声心动图和TDE评估心室功能，并进行运动测试以评估运动能力。采用Mann-Whitney U检验、卡方检验和Pearson相关分析进行统计分析。
与对照组相比，ToF修复术后患者的二尖瓣环收缩期峰值流速（Sm）值显著降低，而在三尖瓣和二尖瓣（MV）处获得的等容收缩时间（IVCT）、等容舒张时间（IVRT）和心肌性能指数（MPI）值显著升高（均p<0.05）。运动时间与完全矫正年龄呈负相关（r=-0.20，p=0.015），运动时间与代谢当量（METS）之间也存在相同的负相关（r=-0.25，p=0.010）。发现MV的IVCT与DE和TDE与METS相关（r=-0.45，p=0.04）。发现左心室MPI与最大心率相关（r=-0.20，p=0.03）。通过DE，三尖瓣减速时间和TDE的Sm峰值流速与METS显著相关（分别为r=-0.30，p=0.04；r=-0.25，p=0.005）。用TDE计算的MPI与最大心率相关（r=-0.15，<0.01）。
即使接受ToF完全矫正手术的患者无症状或临床症状轻微，通过脉搏波TDE评估的MPI指数和运动测试也可能有助于早期诊断右心室功能障碍。
