Shibata Miyuki, Itatani Keiichi, Hayashi Taiyu, Honda Takashi, Kitagawa Atsushi, Miyaji Kagami, Ono Minoru
Department of Cardiac Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Pediatr Cardiol. 2018 Apr;39(4):731-742. doi: 10.1007/s00246-018-1813-z. Epub 2018 Feb 16.
The optimal timing for pulmonary valve replacement after Tetralogy of Fallot (TOF) repair remains controversial. In this study, we estimated the feasibility of using flow energy loss (FEL) to predict right ventricular (RV) deterioration due to pulmonary regurgitation after TOF repair. We examined RV outflow tract (RVOT) flow in nine patients who underwent TOF or double-outlet right ventricle repair in the intervention group (Group I) and compared them with three healthy children in the control group (Group C). We evaluated flow across the RVOT and pulmonary valve by vector flow mapping (VFM) on echocardiography and by phase contrast-magnetic resonance imaging (PC-MRI). Next, we calculated FEL and analyzed the relationship between FEL and clinical parameters of RV function. The mean FEL was significantly greater in Group I than in Group C (p = 0.002). Flow pattern and FEL were comparable by VFM and PC-MRI at the same phase 14.6 years after TOF repair. There was a significant positive correlation for the cardiothoracic ratio with both the mean FEL [correlation coefficient (r) = 0.78; p = 0.012] and the diastolic peak FEL (r = 0.75; p = 0.021) in Group I. There was also a significant positive correlation between the serial change in QRS duration with both the mean FEL (r = 0.82; p = 0.014) and the diastolic FEL (r = 0.70; p = 0.052) in Group I. FEL by VFM is an effective tool for evaluating ventricular deterioration caused by RV workload.
法洛四联症（TOF）修复术后肺动脉瓣置换的最佳时机仍存在争议。在本研究中，我们评估了利用血流能量损失（FEL）预测TOF修复术后因肺动脉反流导致右心室（RV）功能恶化的可行性。我们在干预组（I组）中检查了9例接受TOF或右心室双出口修复术患者的RV流出道（RVOT）血流，并将其与对照组（C组）的3名健康儿童进行比较。我们通过超声心动图上的矢量血流图（VFM）和相位对比磁共振成像（PC-MRI）评估RVOT和肺动脉瓣处的血流。接下来，我们计算FEL并分析FEL与RV功能临床参数之间的关系。I组的平均FEL显著高于C组（p = 0.002）。在TOF修复术后14.6年的同一阶段，VFM和PC-MRI的血流模式和FEL具有可比性。I组中心胸比率与平均FEL [相关系数（r）= 0.78；p = 0.012]和舒张期峰值FEL（r = 0.75；p = 0.021）均呈显著正相关。I组中QRS时限的系列变化与平均FEL（r = 0.82；p = 0.014）和舒张期FEL（r = 0.70；p = 0.052）也均呈显著正相关。VFM测量的FEL是评估由RV负荷引起的心室功能恶化的有效工具。
