de Lorgeril M, Friedli B, Assimacopoulos A
Br Heart J. 1984 Nov;52(5):536-41. doi: 10.1136/hrt.52.5.536.
To investigate the possible causes of left ventricular dysfunction after total correction of tetralogy of Fallot, 84 patients, aged 1 1/2 to 16 years, were studied by left ventricular cineangiography both before and a mean of 4.6 months after operation. Left ventricular ejection fraction and mean velocity of circumferential fibre shortening were calculated; using multivariate analysis the results were correlated with age at operation, the degree of hypoxia and polycythaemia before operation, occurrence of hypoxic spells, and the duration of operative procedures (cardiopulmonary bypass and aortic cross clamping). The postoperative left ventricular ejection fraction was decreased slightly or moderately in 46% of patients. The variable most significantly associated with altered left ventricular function was a history of hypoxic spells. Age, the degree of chronic hypoxia, and polycythaemia did not correlate significantly with left ventricular function indices. Although no correlation was found between the duration of cardiopulmonary bypass and left ventricular ejection fraction, bypass times exceeding 120 minutes were associated with decreased ejection fractions; this was statistically significant and independent of the variable "hypoxic spells". Thus repeated episodes of acute hypoxia and long operative procedures appear to have a deleterious effect on left ventricular function in tetralogy of Fallot.
为了探究法洛四联症完全矫正术后左心室功能障碍的可能原因，对84例年龄在1.5岁至16岁之间的患者进行了研究，在手术前及术后平均4.6个月时均进行了左心室心血管造影。计算左心室射血分数和圆周纤维缩短平均速度；采用多变量分析，将结果与手术时年龄、术前缺氧和红细胞增多症程度、缺氧发作情况以及手术操作时间（体外循环和主动脉阻断时间）相关联。46%的患者术后左心室射血分数轻度或中度降低。与左心室功能改变最显著相关的变量是缺氧发作史。年龄、慢性缺氧程度和红细胞增多症与左心室功能指标无显著相关性。虽然未发现体外循环时间与左心室射血分数之间存在相关性，但体外循环时间超过120分钟与射血分数降低相关；这具有统计学意义且独立于“缺氧发作”变量。因此，急性缺氧反复发作和长时间手术操作似乎对法洛四联症患者的左心室功能有有害影响。
