Sandeep Bhushan, Huang Xin, Xu Fan, Su Pengxiao, Wang Ting, Sun Xiaoke
Department of General Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shanxi, China.
Chengdu medical college, Jinniu district, Rondu avenue, Tianzhu road no 611, Chengdu, 610500, China.
J Cardiothorac Surg. 2019 May 2;14(1):84. doi: 10.1186/s13019-019-0909-8.
Right ventricular restrictive physiology (RVRP) is a common finding after repair of Tetralogy of Fallot (TOF). The characteristic feature of RVRP is the presence of a direct end-diastolic flow (EDFF) during atrial contraction in the main pulmonary artery. This end-diastolic forward flow is caused by increased right ventricular end-diastolic pressure due to right ventricular myocardial stiffness and decreased right ventricular compliance.
Our main objective is to found out the etiology of RVRP in pediatrics patients who underwent for complete repair of Tetralogy of Fallot (TOF).
A total of 50 TOF patients have registered for this study in our hospital from January 2017 to September 2018. The patients were divided in two groups, group A with restrictive physiology and group B without restrictive physiology. The patients selected for this study includes TOF patients, TOF patients with atrial septal defect (ASD), and TOF patients with patent ductus arteriosus (PDA). Ventricular hypertrophy and right heart enlargement were evaluated by electrocardiogram and echocardiography. The other parameters we used to compare between these two groups were sex, age, weight, cardio pulmonary bypass (CPB) time, aortic cross clamping time, transannular patch, SP0, RV/LV pressure, ventricular hypertrophy, right heart (RH) enlargement, tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), TAPSE/PASP ratio, pulmonary annular diameter, intubation time, PICU stay and hematocrit (HCT).
RVRP was identified in 28 patients (58%). Lower SP0 (mean: 84.3 ± 7.9%) with p-value 0.015, transannular patch repair (n = 22, 78.5%) with p-value< 0.001, longer cardiopulmonary bypass (CPB) time (mean: 117.6 ± 23 min) with p-value< 0.001, longer aortic cross clamping time (mean: 91.4 ± 20.26 min) with p-value< 0.001, lower TAPSE, lower PASP,lower TAPSE/PASP ratio and presence of hypertrophy (p-value < 0.001) were identified as etiology for restrictive physiology. It was also found that 77% TOF patients with ASD have a higher risk of RVRP in our study.
In TOF patient's etiology for right ventricular restrictive physiology are associated with lower SP0 transannular patch repair, longer CPB and longer aortic cross clamping time, hypertrophy, lower TAPSE, lower PASP and lower TAPSE/PASP ratio.
右心室限制性生理状态（RVRP）是法洛四联症（TOF）修复术后常见的表现。RVRP的特征性表现是在心房收缩期主肺动脉内存在直接舒张末期血流（EDFF）。这种舒张末期正向血流是由于右心室心肌僵硬度增加导致右心室舒张末期压力升高以及右心室顺应性降低所致。
我们的主要目的是找出接受法洛四联症（TOF）完全修复术的儿科患者中RVRP的病因。
2017年1月至2018年9月期间，共有50例TOF患者在我院登记参加本研究。患者被分为两组，A组为有限制性生理状态的患者，B组为无限制性生理状态的患者。本研究入选的患者包括TOF患者、合并房间隔缺损（ASD）的TOF患者以及合并动脉导管未闭（PDA）的TOF患者。通过心电图和超声心动图评估心室肥厚和右心扩大情况。我们用于比较这两组患者的其他参数包括性别、年龄、体重、体外循环（CPB）时间、主动脉阻断时间、跨环补片、SP0、右心室/左心室压力、心室肥厚、右心（RH）扩大、三尖瓣环平面收缩期位移（TAPSE）、肺动脉收缩压（PASP）、TAPSE/PASP比值、肺动脉环直径、插管时间、在儿科重症监护病房（PICU）的停留时间以及血细胞比容（HCT）。
28例患者（58%）被确定存在RVRP。较低的SP0（平均值：84.3±7.9%），p值为0.015；跨环补片修复（n = 22，78.5%），p值<0.001；较长的体外循环（CPB）时间（平均值：117.6±23分钟），p值<0.001；较长的主动脉阻断时间（平均值：91.4±20.26分钟），p值<0.001；较低的TAPSE、较低的PASP、较低的TAPSE/PASP比值以及存在肥厚（p值<0.001）被确定为限制性生理状态的病因。在我们的研究中还发现，77%合并ASD的TOF患者发生RVRP的风险更高。
在TOF患者中，右心室限制性生理状态的病因与较低的SP0、跨环补片修复、较长的CPB时间和较长的主动脉阻断时间、肥厚、较低的TAPSE、较低的PASP以及较低的TAPSE/PASP比值有关。
