Nair Krishna Kumar Mohanan, Ganapathi Sanjay, Sasidharan Bijulal, Thajudeen Anees, Pillai Harikrishnan Sivadasan, Tharakan Jaganmohan, Titus Thomas, Kumaran Ajitkumar Valaparambil, Sivasubramonian Sivasankaran, Krishnamoorthy Kavassery Mahadevan
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Ann Pediatr Cardiol. 2013 Jan;6(1):24-8. doi: 10.4103/0974-2069.107229.
Right ventricular (RV) dysfunction after surgical repair of Tetralogy of Fallot (TOF) is often asymptomatic and may be detected by tissue Doppler imaging (TDI). The severity of RV dysfunction is more after intracardiac repair with transannular patch (TAP).
One hundred seventy-three adult patients who have undergone surgical repair for TOF were prospectively analyzed for RV function using 2D echocardiography and TDI. RV function was compared between patients who have undergone intracardiac repair with and without TAP.
In both the patient sub-groups, TDI derived myocardial performance index (MPI) and myocardial velocities were abnormal even when 2D echocardiography derived RV functional area change was normal. TDI derived MPI was significantly higher (0.5 ± 0.1 vs. 0.4 ± 0 P < 0.001) and Systolic tricuspid annular velocity (Sa) (9.2 ± 1.3 vs. 10.8 ± 1.6 P < 0.001) was significantly lower in the TAP group. Older age at surgery and severity of pulmonary regurgitation on follow-up were among the significant predictors of TDI derived MPI.
Asymptomatic RV dysfunction in surgically repaired adult TOF atients can be detected by TDI. Extent of RV dysfunction was significantly greater with patients requiring TAP, in those operated at older age, and in patients with severe pulmonary regurgitation.
法洛四联症（TOF）手术修复后右心室（RV）功能障碍通常无症状，可通过组织多普勒成像（TDI）检测到。采用跨环补片（TAP）进行心内修复后，RV功能障碍的严重程度更高。
对173例接受TOF手术修复的成年患者进行前瞻性分析，采用二维超声心动图和TDI评估RV功能。比较接受和未接受TAP心内修复的患者的RV功能。
在两个患者亚组中，即使二维超声心动图得出的RV功能面积变化正常，TDI得出的心肌性能指数（MPI）和心肌速度也异常。TDI得出的MPI在TAP组中显著更高（0.5±0.1对0.4±0，P<0.001），收缩期三尖瓣环速度（Sa）（9.2±1.3对10.8±1.6，P<0.001）显著更低。手术时年龄较大以及随访时肺动脉反流的严重程度是TDI得出的MPI的重要预测因素。
TDI可检测出接受手术修复的成年TOF患者无症状的RV功能障碍。对于需要TAP的患者、手术时年龄较大的患者以及患有严重肺动脉反流的患者，RV功能障碍的程度明显更大。
