Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100, Massa, Italy.
Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy.
Int J Cardiovasc Imaging. 2020 Oct;36(10):1973-1982. doi: 10.1007/s10554-020-01891-9. Epub 2020 May 27.
The hemodynamic impact of residual pulmonary regurgitation (PR) in repaired Tetralogy of Fallot (rTOF) has been well demonstrated. However, markers driving the decision making process to indicate the ideal timing of pulmonary valve replacement (PVR) are still uncertain. Furthermore, very few studies have included the right atrium (RA) dilatation as a preoperative risk factor for post-PVR clinical adverse outcome. The aim of this study was to investigate the impact of pre-PVR right atrial dilation on adverse outcomes in rTOF. We retrospectively reviewed from our CMR database all rTOF patients who underwent CMR study before and after PVR. Detailed clinical and surgical history were collected, in addition to imaging data. The composite primary and secondary post-PVR end points were also recorded. The study cohort consisted of 41 patients (mean age at PVR repair 27.4 ± 10 years). As expected, end-diastolic and end-systolic right ventricle (RV) volumes significantly decreased after PVR (p < 0.001). The RV reverse remodeling, defined by ΔRVEDVi and ΔRVESVi, was associated with both pre-PVR RVEDVi and RVESVi. The higher the pre-PVR RV volumes, more the RV reverse remodeling will be obtained post-surgery. Patients who experienced an adverse outcome were older at pre-PVR, they had a higher Nt-ProBNP, worse VO/kg/min, more significant tricuspid regurgitation and more dilated RA. The association with the RA dilatation persists and becomes even more significant if we exclude patients who had tricuspid repair beside RVOT surgical reconstruction. Besides RV volumes and function, RA dimensions may play a pivotal role in the decision making of TOF patients.
残余肺动脉瓣反流（PR）对修复后的法洛四联症（rTOF）的血液动力学影响已得到充分证实。然而，指导决策过程以确定肺动脉瓣置换（PVR）理想时机的标志物仍不确定。此外，很少有研究将右心房（RA）扩张作为 PVR 后临床不良结局的术前危险因素。本研究旨在探讨术前右心房扩张对 rTOF 患者 PVR 后不良结局的影响。我们从 CMR 数据库中回顾性分析了所有在 PVR 前后接受 CMR 检查的 rTOF 患者。除了影像学数据外，还收集了详细的临床和手术史。还记录了复合 PVR 后主要和次要终点。研究队列包括 41 名患者（PVR 修复时的平均年龄为 27.4±10 岁）。如预期的那样，PVR 后舒张末期和收缩末期右心室（RV）容积明显减小（p<0.001）。RV 反向重构，由 RVEDVi 和 RVESVi 的Δ值定义，与 PVR 前 RVEDVi 和 RVESVi 相关。术前 RV 容积越高，术后 RV 反向重构越多。术前发生不良事件的患者年龄较大，Nt-ProBNP 较高，VO/kg/min 较差，三尖瓣反流更严重，RA 更扩张。如果排除 RVOT 外科重建之外还进行三尖瓣修复的患者，RA 扩张与不良事件之间的关联仍然存在，而且变得更加显著。除了 RV 容积和功能外，RA 尺寸在 TOF 患者的决策中可能起着关键作用。
