Fan Qiang, Wang Yabo, An Qi, Ling Yunfei
Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
Int J Surg. 2025 Jun 1;111(6):3979-3988. doi: 10.1097/JS9.0000000000002367. Epub 2025 Apr 1.
Right ventricular dysfunction following surgical correction of tetralogy of Fallot (TOF) remains a major determinant of long-term morbidity and mortality in survivors. Despite advancements in surgical techniques, residual anatomical abnormalities - including pulmonary regurgitation, right ventricular outflow tract obstruction, abnormal coronary artery anatomy, scar formation, and tricuspid regurgitation - synergistically drive ventricular remodeling and functional decline. This review synthesizes evidence on the pathophysiological interplay of these anatomical substrates. Key imaging modalities, such as 3D late gadolinium enhancement cardiac magnetic resonance, and artificial intelligence tools enhance risk stratification for ventricular arrhythmias. We propose a hierarchical management framework prioritizing hemodynamic stabilization, electrophysiological substrate modification and individualized strategies for concomitant lesions considerations. This work aims to bridge anatomical insights with therapeutic innovations, offering a roadmap for improving longevity and quality of life in repaired TOF patients.
法洛四联症（TOF）手术矫正后的右心室功能障碍仍然是幸存者长期发病率和死亡率的主要决定因素。尽管手术技术有所进步，但残余的解剖学异常——包括肺动脉反流、右心室流出道梗阻、冠状动脉解剖异常、瘢痕形成和三尖瓣反流——协同驱动心室重塑和功能衰退。本综述综合了关于这些解剖学基础病理生理相互作用的证据。关键的成像方式，如三维延迟钆增强心脏磁共振成像，以及人工智能工具可增强室性心律失常的风险分层。我们提出了一个分级管理框架，优先考虑血流动力学稳定、电生理基质改良以及针对合并病变的个体化策略。这项工作旨在将解剖学见解与治疗创新联系起来，为提高TOF修复患者的寿命和生活质量提供路线图。
