Oku H, Shirotani H, Sunakawa A, Yokoyama T
Jpn Circ J. 1986 Sep;50(9):845-9. doi: 10.1253/jcj.50.845.
Late results were studied in 63 patients who underwent complete repair of tetralogy of Fallot. Mild pulmonary stenosis (PS) was present in 73%, moderate PS in 17% and severe PS in 10% of the patients. When a transannular patch was used, wider enlargement of the pulmonary annulus did not always relate to a decrease in right ventricular pressure and right ventricular to pulmonary artery pressure gradient in the late postoperative period. Pulmonary regurgitation (PR) of grade 2 or less did not relate to the late postoperative hemodynamics and cardiac function. PR of grade 3 or over led to right ventricular and pulmonary artery hypertension, and to increases in right ventricular end-diastolic volume and CTR. PR of grade 4 impaired left ventricular function. PR of grade 3 or over with moderate PS led to elevation in right ventricular end-diastolic pressure. In patients with mild PS and PR of grade 2 or less, late postoperative hemodynamics and cardiac function were excellent. To maintain excellent postoperative hemodynamics and cardiac function, it is imperative to obtain PR of grade 2 or less and to use a procedure which will lead to excellent development of the pulmonary annulus. In conventional procedures using a transannular patch, a CSAI of less than 2.5 cm2/m2 and precise coaptation between the original pulmonary cusp and the cusp mounted on the patch will aid in avoiding significant PR.
对63例接受法洛四联症完全修复术的患者的远期结果进行了研究。73%的患者存在轻度肺动脉狭窄（PS），17%为中度PS，10%为重度PS。当使用跨环补片时，肺动脉环更广泛的扩大并不总是与术后晚期右心室压力及右心室与肺动脉压力梯度的降低相关。2级或以下的肺动脉反流（PR）与术后晚期血流动力学和心功能无关。3级或以上的PR导致右心室和肺动脉高压，以及右心室舒张末期容积和心胸比率（CTR）增加。4级PR损害左心室功能。3级或以上的PR合并中度PS导致右心室舒张末期压力升高。在轻度PS且PR为2级或以下的患者中，术后晚期血流动力学和心功能良好。为保持良好的术后血流动力学和心功能，必须获得2级或以下的PR，并采用能使肺动脉环良好发育的手术方法。在使用跨环补片的传统手术中，体表面积校正指数（CSAI）小于2.5 cm2/m2以及原肺动脉瓣叶与补片上安装的瓣叶之间精确对合有助于避免显著的PR。
