Lee Cheul, Lee Chang-Ha, Kwak Jae Gun, Kim Seong-Ho, Shim Woo-Sup, Lee Sang Yun, Jang So-Ick, Park Su-Jin, Kim Yang Min
Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea.
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2589-95. doi: 10.1016/j.jtcvs.2014.07.051. Epub 2014 Aug 1.
The aim of the present study was to identify the factors associated with right ventricular (RV) dilatation and dysfunction in patients with chronic pulmonary regurgitation (PR) after repair of tetralogy of Fallot.
From April 2002 to June 2013, 218 patients with repaired tetralogy of Fallot underwent magnetic resonance imaging; 165 (76%) underwent transannular repair and 36 (17%) underwent nontransannular repair. Linear regression analyses were used to identify the predictors for RV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), and ejection fraction.
On univariable analysis, male sex, ventricular septal defect (VSD) closure through the right ventricle, larger pulmonary artery index, and greater PR fraction were associated with greater RV volume indexes. Multivariable analyses identified male sex (β = 17.55, P < .001 for RV EDVI; β = 14.08, P = .001 for RV ESVI), VSD closure through RV (β = 8.49, P = .048 for RV ESVI), longer interval since repair (β = 1.29, P = .014 for RV EDVI), and greater PR fraction (β = 1.92, P < .001 for RV EDVI; β = 1.38, P < .001 for RV ESVI) as independent predictors for greater RV volume indexes. On univariable analysis, male sex, VSD closure through the right ventricle, and greater PR fraction were associated with a lower RV ejection fraction. Multivariable analysis identified male sex (β = -3.10, P = .018), VSD closure through the right ventricle (β = -3.05, P = .020), and greater PR fraction (β = -0.27, P < .001) as independent predictors for a lower RV ejection fraction.
Male sex, VSD closure through the right ventricle, longer interval since repair, and greater PR fraction were independent predictors of RV dilatation after tetralogy of Fallot repair. Male sex, VSD closure through the right ventricle, and greater PR fraction were also independent predictors of RV dysfunction.
本研究旨在确定法洛四联症修复术后慢性肺反流（PR）患者右心室（RV）扩张及功能障碍的相关因素。
2002年4月至2013年6月，218例法洛四联症修复术后患者接受了磁共振成像检查；165例（76%）接受了跨环修补术，36例（17%）接受了非跨环修补术。采用线性回归分析确定右心室舒张末期容积指数（EDVI）、收缩末期容积指数（ESVI）和射血分数的预测因素。
单因素分析显示，男性、经右心室关闭室间隔缺损（VSD）、较大的肺动脉指数和较高的PR分数与较大的右心室容积指数相关。多因素分析确定男性（右心室EDVI的β = 17.55，P <.001；右心室ESVI的β = 14.08 ，P = 0.001）、经右心室关闭VSD（右心室ESVI的β = 8.49，P = 0.048）、修复术后间隔时间较长（右心室EDVI的β = 1.29，P = 0.014）和较高的PR分数（右心室EDVI的β = 1.92，P <.001；右心室ESVI的β = 1.38，P <.001）是右心室容积指数增大的独立预测因素。单因素分析显示，男性、经右心室关闭VSD和较高的PR分数与较低的右心室射血分数相关。多因素分析确定男性（β = -3.10，P = 0.018）、经右心室关闭VSD（β = -3.05，P = 0.020）和较高的PR分数（β = -0.27，P <.001）是右心室射血分数降低的独立预测因素。
男性、经右心室关闭VSD、修复术后间隔时间较长和较高的PR分数是法洛四联症修复术后右心室扩张的独立预测因素。男性、经右心室关闭VSD和较高的PR分数也是右心室功能障碍的独立预测因素。
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