Terol Covadonga, Kamphuis Vivian P, Hazekamp Mark G, Blom Nico A, Ten Harkel Arend D J
Division of Paediatric Cardiology, Department of Paediatrics, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Netherlands Heart Institute, Utrecht, The Netherlands.
Pediatr Cardiol. 2020 Jun;41(5):1042-1050. doi: 10.1007/s00246-020-02355-6. Epub 2020 May 4.
Surgical repair of Tetralogy of Fallot (ToF) is usually performed in the first months of life with low early postoperative mortality. During long-term follow-up, however, both right (RV) and left ventricular (LV) performances may deteriorate. Tissue Doppler imaging (TDI) and speckle tracking echocardiography (ST) can unmask a diminished RV and LV performance. The objective of the current study was to assess the cardiac performance before and shortly after corrective surgery in ToF patients using conventional, TDI and ST echocardiographic techniques. Thirty-six ToF patients after surgery were included. Transthoracic echocardiography including TDI and ST techniques was performed preoperatively and at hospital discharge after surgery (10 days to 4 weeks after surgery). Median age at surgery was 7.5 months [5.5-10.9]. Regarding the LV systolic function there was a significant decrease in interventricular septum (IVS) S' at discharge as compared to preoperatively (pre IVS S' = 5.4 ± 1.4; post IVS S' = 3.9 ± 1.2; p < 0.001) and in global longitudinal peak strain (GLS) (pre = - 18.3 ± 3.4; post = - 14.2 ± 4.1; p = 0.003); but not in the fractional shortening (FS). Both conventional and TDI parameters showed a decrease in diastolic function at discharge. Tricuspid Annular Plane Systolic Excursion and RV S' were significantly lower before discharge. When assessing the RV diastolic performance, only the TDI demonstrated a RV impairment. There was a negative correlation between age at surgery and postoperative LV GLS (R = - 0.41, p = 0.031). There seems to be an impairment in left and right ventricle performance at discharge after ToF corrective surgery compared to preoperatively. This is better determined with TDI and ST strain imaging than with conventional echocardiography.
法洛四联症（ToF）的外科修复通常在生命的最初几个月进行，术后早期死亡率较低。然而，在长期随访中，右心室（RV）和左心室（LV）的功能都可能恶化。组织多普勒成像（TDI）和斑点追踪超声心动图（ST）可以揭示RV和LV功能的减弱。本研究的目的是使用传统、TDI和ST超声心动图技术评估ToF患者矫正手术前后的心脏功能。纳入了36例术后ToF患者。术前和术后出院时（术后10天至4周）进行了包括TDI和ST技术的经胸超声心动图检查。手术时的中位年龄为7.5个月[5.5 - 10.9]。关于左心室收缩功能，与术前相比，出院时室间隔（IVS）S'显著降低（术前IVS S' = 5.4±1.4；术后IVS S' = 3.9±1.2；p < 0.001），整体纵向峰值应变（GLS）也降低（术前 = -18.3±3.4；术后 = -14.2±4.1；p = 0.003）；但缩短分数（FS）没有变化。传统和TDI参数均显示出院时舒张功能降低。出院前三尖瓣环平面收缩期位移和RV S'显著降低。在评估RV舒张功能时，只有TDI显示RV受损。手术时年龄与术后LV GLS之间存在负相关（R = -0.41，p = 0.031）。与术前相比，ToF矫正手术后出院时左、右心室功能似乎受损。与传统超声心动图相比，TDI和ST应变成像能更好地确定这一点。
