O'Meagher Shamus, Ganigara Madhusudan, Tanous David J, Celermajer David S, Puranik Rajesh
The University of Sydney, Faculty of Medicine, Sydney, Australia.
Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
Int J Cardiol Heart Vessel. 2014 Mar 2;3:28-31. doi: 10.1016/j.ijchv.2014.02.003. eCollection 2014 Jun.
The time course of progressive dilatation of the right ventricle (RV) in adults with pulmonary regurgitation (PR) late after repair of tetralogy of Fallot (TOF) is poorly characterized.
We analysed cardiac MRI data (1.5 T) from 14 adult repaired TOF patients (26 ± 11 years of age) with dilated RVs and known significant PR, on 2 separate visits with a between MRI period of 2.1 ± 1.0 years.
Indexed RV end diastolic volume (RVEDVi) increased over 2 years (142 ± 19 to 151 ± 20 mL/m, = 0.005; change = 8.4 ± 9.3 mL/m, range = - 6 to 26 mL/m; annual mL/m increase = 4.3 ± 4.6; annual percentage increase = 3.1 ± 3.3%), whilst RV ejection fraction decreased (53 ± 8 to 49 ± 7 %, = 0.039). RV muscular corpus (RVMC) EDVi significantly increased (130 ± 19 to 138 ± 20 mL/m, = 0.014), whereas RV outflow tract (RVOT) EDVi did not (12 ± 7 vs 13 ± 6 mL/m, = 0.390). No other RV or LV measures significantly changed during the inter-MRI period. The change in RVEDVi correlated significantly with LV end diastolic volume ( = - 0.582, = 0.029), RVEDVi:LVEDVi ( = 0.6, = 0.023) and RVMC EDVi ( = 0.9, < 0.001) but not RVOT EDVi ( = 0.225, = 0.459).
Adult repaired TOF patients with free PR experienced a mean 3.1%, or 4.3 mL/m, annual increase in RVEDVi, unrelated to the initial RVEDVi or PR fraction. The increase in RVEDVi was due to RVMC rather than RVOT dilatation. This provides a guide to the frequency of MR surveillance and insights into the natural history of progressive RV dilatation in this setting.
法洛四联症（TOF）修复术后晚期发生肺反流（PR）的成人患者，右心室（RV）进行性扩张的时间进程特征尚不明确。
我们分析了14例接受TOF修复术的成年患者（年龄26±11岁）的心脏磁共振成像（MRI）数据（1.5T），这些患者右心室扩张且存在显著PR，在两次独立就诊时进行MRI检查，两次检查间隔时间为2.1±1.0年。
右心室舒张末期容积指数（RVEDVi）在2年中增加（从142±19增至151±20 mL/m²，P = 0.005；变化量 = 8.4±9.3 mL/m²，范围 = -6至26 mL/m²；每年增加量 = 4.3±4.6 mL/m²；每年增加百分比 = 3.1±3.3%），而右心室射血分数降低（从53±8降至49±7%，P = 0.039）。右心室肌性组织（RVMC）舒张末期容积指数显著增加（从130±19增至138±20 mL/m²，P = 0.014），而右心室流出道（RVOT）舒张末期容积指数未增加（分别为12±7和13±6 mL/m²，P = 0.390）。在两次MRI检查期间，右心室或左心室的其他测量指标均无显著变化。RVEDVi的变化与左心室舒张末期容积显著相关（r = -0.582，P = 0.029）、RVEDVi:LVEDVi（r = 0.6，P = 0.023）和RVMC舒张末期容积指数（r = 0.9，P < 0.001），但与RVOT舒张末期容积指数无关（r = 0.225，P = 0.459）。
患有游离PR的成年TOF修复患者，RVEDVi平均每年增加3.1%或4.3 mL/m²，与初始RVEDVi或PR分数无关。RVEDVi的增加是由于RVMC而非RVOT扩张所致。这为磁共振监测的频率提供了指导，并有助于深入了解这种情况下右心室进行性扩张的自然病程。
