Associate professor of cardiology and adult congenital heart disease, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-asr Ave, adjacent to Mellat Park, Tehran, Iran.
Fellow of Cardiology, Rajaei Cardiovascular Medical and Research Center, School of medicine, Iran University of Medical Sciences, Tehran, Iran.
Ann Cardiol Angeiol (Paris). 2023 Feb;72(1):44-47. doi: 10.1016/j.ancard.2022.11.005. Epub 2022 Nov 23.
Many patients with repaired tetralogy of Fallot require reoperation in the medium to long-term for residual pulmonary valve regurgitation. Best timing for pulmonary valve replacement remains controversial. A balance needs to be found between protecting the patients from permanent right ventricular damage and insertion of a prosthetic valve with its inherent issues. In the current study we sought to investigate the right and left ventricular functional recovery following valve replacement in our tertiary care institution.
In a retrospective cross-sectional study patients with history of total correction of tetralogy of Fallot who had undergone pulmonary valve replacement due to severe pulmonary regurgitation between 2003-2018 were evaluated for post intervention right and left ventricular functional recovery. Clinical and full echocardiographic data before and after the surgery were recorded and compared. There was statistically significant improvement in RV size and function post pulmonary valve replacement. There was no statistically significant improvement in left ventricular systolic function. Twenty percent of patient had persisting severe right ventricular enlargement at least twelve months post-surgery. No patient had fully normalized right ventricular size and function in follow-up.
Pulmonary valve replacement leads to improvement in right ventricular size and function in patients with repaired tetralogy of Fallot. However normalization of functional parameters did not occur and the majority of the patients have residual right and left ventricular dysfunction following redo valve replacement surgery.
许多法洛四联症修复术后的患者在中、长期需要因残余肺动脉瓣反流而再次手术。肺动脉瓣置换的最佳时机仍存在争议。需要在保护患者免受永久性右心室损伤和植入人工瓣膜及其固有问题之间取得平衡。在本研究中，我们试图在我们的三级护理机构中研究瓣膜置换术后右心室和左心室的功能恢复情况。
在一项回顾性的横断面研究中，评估了 2003 年至 2018 年间因严重肺动脉瓣反流而接受肺动脉瓣置换术的法洛四联症根治术后患者术后右心室和左心室功能恢复情况。记录并比较了手术前后的临床和完整超声心动图数据。肺动脉瓣置换术后 RV 大小和功能有统计学显著改善。左心室收缩功能无统计学显著改善。20%的患者在手术后至少 12 个月仍存在严重的右心室扩大。在随访中，没有患者的右心室大小和功能完全正常化。
肺动脉瓣置换可改善修复后的法洛四联症患者的右心室大小和功能。然而，功能参数并未正常化，大多数患者在再次瓣膜置换手术后仍存在残余右心室和左心室功能障碍。
