Śpiewak Mateusz, Petryka-Mazurkiewicz Joanna, Mazurkiewicz Łukasz, Miłosz-Wieczorek Barbara, Kowalski Mirosław, Biernacka Elżbieta K, Hoffman Piotr, Marczak Magdalena
National Institute of Cardiology, Warsaw, Poland.
Pol J Radiol. 2020 Nov 3;85:e607-e612. doi: 10.5114/pjr.2020.101058. eCollection 2020.
Right ventricular (RV) outflow tract obstruction (RVOTO) was demonstrated to be protective against RV dilatation in patients with repaired tetralogy of Fallot and chronic pulmonary regurgitation (PR). We hypothesised that the presence of additional haemodynamic abnormalities (more than mild tricuspid regurgitation, residual ventricular septal defect) reduces this protective association. Accordingly, we aimed to assess the impact of PR on RV size and function in this population.
Consecutive patients with additional haemodynamic abnormalities after tetralogy of Fallot (TOF) repair, who had undergone cardiovascular magnetic resonance, were included.
Out of 90 patients studied, 18 individuals (mean age 32.5 ± 10.7 years, 72.2% males) met the inclusion criteria. There were no differences in RV volumes and ejection fraction between patients with and without RVOTO. Neither PR fraction (PRF) nor PR volume (PRV) correlated with RV end-diastolic volume ( = 0.36; = 0.15 and = 0.37; = 0.14, respectively, for PRF and PRV) or RV end-systolic volume ( = 0.2; = 0.42 and = 0.19; = 0.45, respectively, for PRF and PRV). Similarly, no significant correlations were observed between PRF or PRV and RV ejection fraction ( = -0.04; = 0.87 and = -0.03; = 0.9, respectively).
Additional haemodynamic abnormalities are associated with the abolition of the protective effect of RVOTO on RV size. There was no significant relationship between measures of PR and RV volumes in patients after TOF repair with concomitant haemodynamic abnormalities. These abnormalities acted as confounding factors in the assessment of the impact of pulmonary regurgitation on RV size and function.
在法洛四联症修复术后合并慢性肺动脉反流（PR）的患者中，右心室（RV）流出道梗阻（RVOTO）被证明对RV扩张具有保护作用。我们假设，存在额外的血流动力学异常（超过轻度三尖瓣反流、残余室间隔缺损）会削弱这种保护关联。因此，我们旨在评估PR对该人群RV大小和功能的影响。
纳入法洛四联症（TOF）修复术后存在额外血流动力学异常且接受过心血管磁共振检查的连续患者。
在研究的90例患者中，18例（平均年龄32.5±10.7岁，72.2%为男性）符合纳入标准。有RVOTO和无RVOTO的患者之间，RV容积和射血分数无差异。PR分数（PRF）和PR容积（PRV）与RV舒张末期容积均无相关性（PRF和PRV分别为r = 0.36，P = 0.15和r = 0.37，P = 0.14），与RV收缩末期容积也均无相关性（PRF和PRV分别为r = 0.2，P = 0.42和r = 0.19，P = 0.45）。同样，PRF或PRV与RV射血分数之间也未观察到显著相关性（分别为r = -0.04，P = 0.87和r = -0.03，P = 0.9）。
额外的血流动力学异常与RVOTO对RV大小的保护作用消失有关。在TOF修复术后合并血流动力学异常的患者中，PR指标与RV容积之间无显著关系。这些异常在评估肺动脉反流对RV大小和功能的影响时起到了混杂因素的作用。
