Choi Su Jin, Kwon Jung Eun, Roh Da Eun, Hyun Myung Chul, Jung Hanna, Lee Young Ok, Cho Joon Yong, Kim Yeo Hyang
Department of Pediatrics, School of Medicine, Kyungpook National University, Division of Pediatric Cardiology, Kyungpook National University Children's Hospital, Daegu, Korea.
Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
Clin Exp Pediatr. 2020 May;63(5):189-194. doi: 10.3345/kjp.2019.01060. Epub 2019 Nov 8.
The decision to use transannular patching (TAP) during tetralogy of Fallot (TOF) repair depends on the pulmonary valve annulus size; the z score of the pulmonary annulus is the most commonly used predictor. However, definitive results are not obtained with z scores as different z score data sets are used for different parameters.
This study aimed to identify the echocardiographic and other key factors that warranted a change in the surgical method during TOF surgery.
Sixty-two patients were enrolled and divided into a pulmonary valve (PV) preservation group and a TAP group. Their medical records were reviewed.
The z score for PV annulus (PVA), ratio of the PVA to aortic annulus size, and ratio of PVA to descending aorta (DAO) size were significantly different between the PV preservation and TAP groups (-1.72±1.52 vs. -3.07±1.94, P=0.004; 0.62±0.12 vs. 0.50±0.14, P=0.002; and 1.32±0.32 vs. 1.07±0.36, P= 0.008, respectively). For TAP repair, the PVA z score had a sensitivity of 65.4% and specificity of 73.1%, ratio of PVA to aortic annulus size had a sensitivity of 73.1% and specificity of 65.4%, and ratio of PVA to DAO size had a sensitivity of 69.2% and specificity of 57.7%. The TAP group showed more monocuspid PVs (P=0.011), while the PV preservation group showed more tricuspid PVs (P=0.027). Commissurotomy was more frequently performed in the PV preservation group than in the TAP group (P=0.001). Of patients with commissurotomy, 58% showed a PV z score<-2.
Although various echocardiographic parameters may serve as predictors for determining surgical methods for TOF patients, the PV morphology and tissue characteristics should also be considered.
法洛四联症（TOF）修复术中使用跨环补片（TAP）的决定取决于肺动脉瓣环大小；肺动脉环的z评分是最常用的预测指标。然而，由于不同的参数使用不同的z评分数据集，因此无法获得确切的结果。
本研究旨在确定在TOF手术期间需要改变手术方法的超声心动图及其他关键因素。
纳入62例患者，并分为肺动脉瓣（PV）保留组和TAP组。回顾了他们的病历。
PV保留组和TAP组之间的PV环（PVA）z评分、PVA与主动脉环大小的比值以及PVA与降主动脉（DAO）大小的比值存在显著差异（分别为-1.72±1.52对-3.07±1.94，P = 0.004；0.62±0.12对0.50±0.14，P = 0.002；以及1.32±0.32对1.07±0.36，P = 0.008）。对于TAP修复，PVA z评分的敏感性为65.4%，特异性为73.1%，PVA与主动脉环大小的比值敏感性为73.1%，特异性为65.4%，PVA与DAO大小的比值敏感性为69.2%，特异性为57.7%。TAP组显示更多的单叶PV（P = 0.011），而PV保留组显示更多的三叶PV（P = 0.）。PV保留组比TAP组更频繁地进行瓣膜交界切开术（P = 0.001）。在进行瓣膜交界切开术的患者中，58%的患者PV z评分<-2。
虽然各种超声心动图参数可作为确定TOF患者手术方法的预测指标，但也应考虑PV形态和组织特征。
