Janousek J, Hruda J, Bartáková H, Vorisková M, Hucín B, Hammer J, Radvanský J, Reich O, Samánek M
Herzzentrum Fakultätskrankenhauses Motol, Prag.
Z Gesamte Inn Med. 1989 Jun 1;44(11):323-6.
41 patients after surgical correction of the tetralogy of Fall of aged 2-24 years (mean 11.2 y.) were followed for 12-65 months (mean 39.5 m.) for known or suspected dysrhythmias. 24-hour ambulatory ECG and exercise testing demonstrated nonsignificant ventricular ectopy (grade 0-1 according to a modified Lown classification) in 28 patients (group I) and significant (grade 2-5) ventricular dysrhythmias in the remaining 13 patients (group II). There were 2 cases of sudden late death in group II, whereas all patients in group I are alive. The victims of sudden death had no, other serious dysrhythmias and received no antiarrhythmic treatment. Ejection fraction of the functional part of the right ventricle estimated by radionuclide angiocardiography was not different in both groups whereas, global right ventricular ejection fraction differed nearly significantly (group I: 39.6 +/- 8.3%, group II: 31.9 +/- 10.4%, p = 0.052). Thus, a diminished global right ventricular ejection fraction caused by an extensive resection and large patch in the right ventricular outflow tract may be connected with the occurrence of higher grades of ventricular ectopy. These may lead to sudden late death.
41例年龄在2至24岁（平均11.2岁）的法洛四联症手术矫正术后患者，因已知或疑似心律失常接受了12至65个月（平均39.5个月）的随访。24小时动态心电图和运动试验显示，28例患者（I组）存在无明显意义的室性早搏（根据改良的洛恩分类为0 - 1级），其余13例患者（II组）存在显著（2 - 5级）室性心律失常。II组有2例晚期猝死病例，而I组所有患者均存活。猝死患者无其他严重心律失常，且未接受抗心律失常治疗。通过放射性核素心血管造影术估计的右心室功能部分的射血分数在两组中无差异，而整体右心室射血分数差异接近显著（I组：39.6 +/- 8.3%，II组：31.9 +/- 10.4%，p = 0.052）。因此，右心室流出道广泛切除和大面积补片导致的整体右心室射血分数降低可能与更高等级的室性早搏的发生有关。这些可能导致晚期猝死。
