Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Am Soc Echocardiogr. 2018 Jul;31(7):816-821. doi: 10.1016/j.echo.2018.02.013. Epub 2018 Apr 4.
Right ventricular (RV) dysfunction is associated with adverse long-term outcomes in patients with tetralogy of Fallot. Little is known about RV function in the first years after surgical repair. The aim of this study was to investigate perioperative changes in myocardial deformation using global longitudinal strain.
A retrospective analysis of patients with surgically repaired tetralogy of Fallot was performed. Global longitudinal peak systolic RV strain was measured on early postoperative echocardiograms, two subsequent postoperative echocardiograms through 2 years postoperatively, and preoperative echocardiograms, when available. Preoperative and late follow-up strain was compared with strain in 0- to 8-month-old and 1- to 4-year-old control subjects, respectively.
Forty-seven patients were included. Compared with postoperative strain (7 ± 7 days postoperatively), strain at follow-up 1 (8.3 ± 4 months postoperatively) was significantly improved (-12.3 ± 3.3% vs -18.8 ± 2.5%, P < .001), with no additional improvement 23.2 ± 6 months postoperatively (-18.8 ± 2.5% vs -19.8 ± 3.1%, P = .12). Postoperative strain was worse than preoperative strain (n = 25, -12.5 ± 3.6% vs -18.4 ± 2.9%, P < .001). Compared with control subjects, preoperative strain was similar (-19.3 ± 3.8% vs -18.4 ± 2.9%, P = .30), though late follow-up strain was significantly worse (-27.7 ± 2.8% vs -19.8 ± 3.1%, P < .001).
RV global longitudinal strain worsens in the early postoperative period following surgical repair of tetralogy of Fallot but recovers through 2 postoperative years. Despite recovery to preoperative values, the presence of RV dysfunction compared with control subjects suggests that long-term dysfunction may begin early. The trajectory of RV dysfunction through the later years needs further study.
右心室（RV）功能障碍与法洛四联症患者的不良长期预后相关。关于法洛四联症术后早期 RV 功能的信息知之甚少。本研究旨在通过整体纵向应变来探讨围手术期心肌变形的变化。
对接受手术修复的法洛四联症患者进行回顾性分析。在术后早期的超声心动图上测量 RV 收缩期整体纵向峰值应变，在术后 2 年的后续 2 次超声心动图上测量，在术前超声心动图上（如果有）测量。将术前和晚期随访的应变分别与 0-8 月龄和 1-4 岁的对照组进行比较。
共纳入 47 例患者。与术后应变（术后 7±7 天）相比，随访 1 时的应变（术后 8.3±4 个月）显著改善（-12.3±3.3%比-18.8±2.5%，P<0.001），23.2±6 个月后无进一步改善（-18.8±2.5%比-19.8±3.1%，P=0.12）。术后应变比术前差（n=25，-12.5±3.6%比-18.4±2.9%，P<0.001）。与对照组相比，术前应变相似（-19.3±3.8%比-18.4±2.9%，P=0.30），但晚期随访应变明显更差（-27.7±2.8%比-19.8±3.1%，P<0.001）。
法洛四联症术后早期 RV 整体纵向应变恶化，但在术后 2 年内恢复。尽管恢复到术前值，但与对照组相比，RV 功能障碍的存在表明长期功能障碍可能很早就开始了。RV 功能障碍在以后几年的轨迹需要进一步研究。
