Department of Radiology, Louis Pradel Hospital, CREATIS, UMR CNRS 5520, INSERM U1044, Lyon, France.
Am J Cardiol. 2012 Dec 15;110(12):1828-35. doi: 10.1016/j.amjcard.2012.08.017. Epub 2012 Sep 14.
Pulmonary valve regurgitation is the most common complication after complete repair of tetralogy of Fallot. The benefits of pulmonary valve replacement (PVR) on right ventricular (RV) volumes is well established. However, the effect on left ventricular (LV) function is still debated. We aimed to determine the evolution of LV function after PVR and assess the contribution of the interventricular septum (IVS) motion. A total of 21 patients (mean age 30.1 ± 14.1 years) presenting with a history of complete repair of tetralogy of Fallot and requiring PVR prospectively underwent cardiac magnetic resonance imaging before and after PVR to measure the end-diastolic volume (EDV), end systolic volume, and ejection fraction for the LV and RV chambers. Maximal excursion of the IVS was also calculated to quantify abnormal septal motion. The LV-EDV and LV-end systolic volume was 80 ± 27 and 40 ± 19.5 ml/m(2) before PVR and 81.5 ± 23 and 35 ± 14 ml/m(2) after PVR, respectively, leading to a significant increase in LV ejection fraction of 6.1 ± 4.9% (51 ± 8.2% before and 57 ± 6.8% after PVR, p = 0.0003). Also, a significant reduction in RV-EDV (p = 0.0001) and RV end-systolic volume (p = 0.0001) was seen but without improvement in the RV ejection fraction. The maximum IVS excursion decreased after PVR (9.2 ± 3.4 mm before and 6.8 ± 3.6 mm after; p = 0.002). LV ejection fraction improvement correlated with RV-EDV before PVR (ρ = 0.43; p = 0.049). The maximum IVS excursion correlated with RV-EDV before and after PVR but was independent of LV ejection fraction improvement. In conclusion, the results of the present study have demonstrated a significant improvement in LV ejection fraction after PVR that correlated with the pre-PVR RV-EDV but was independent of IVS motion improvement.
肺动脉瓣反流是法洛四联症根治术后最常见的并发症。肺动脉瓣置换术（PVR）对右心室（RV）容积的益处已得到充分证实。然而，其对左心室（LV）功能的影响仍存在争议。我们旨在确定 PVR 后 LV 功能的演变，并评估室间隔（IVS）运动的贡献。总共 21 例（平均年龄 30.1 ± 14.1 岁）有法洛四联症根治术后病史并需要 PVR 的患者前瞻性地接受了心脏磁共振成像检查，以测量 LV 和 RV 腔的舒张末期容积（EDV）、收缩末期容积和射血分数。还计算了 IVS 的最大偏移量，以量化异常的隔瓣运动。PVR 前 LV-EDV 和 LV-收缩末期容积分别为 80 ± 27 和 40 ± 19.5ml/m²，PVR 后分别为 81.5 ± 23 和 35 ± 14ml/m²，导致 LV 射血分数显著增加 6.1 ± 4.9%（PVR 前 51 ± 8.2%，PVR 后 57 ± 6.8%，p = 0.0003）。还观察到 RV-EDV（p = 0.0001）和 RV 收缩末期容积（p = 0.0001）显著减少，但 RV 射血分数没有改善。PVR 后 IVS 最大偏移量减少（PVR 前 9.2 ± 3.4mm，PVR 后 6.8 ± 3.6mm，p = 0.002）。LV 射血分数的改善与 PVR 前 RV-EDV 相关（ρ=0.43；p=0.049）。IVS 最大偏移量与 PVR 前后 RV-EDV 相关，但与 LV 射血分数改善无关。总之，本研究结果表明，PVR 后 LV 射血分数显著改善，与 PVR 前 RV-EDV 相关，但与 IVS 运动改善无关。
