Rocchini A P, Rosenthal A, Freed M, Castaneda A R, Nadas A S
Circulation. 1977 Aug;56(2):305-10. doi: 10.1161/01.cir.56.2.305.
The etiology of chronic congestive heart failure (CHF) after repair of tetralogy of Fallot was determined in 102 patients consecutively catheterized 1 to 12 years postoperatively. Chronic CHF was observed in 36/102 patients. The most prevalent abnormality leading to congestive failure (31/36) was a large residual ventricular septal defect alone or in combination with other lesions. All postoperative patients with pulmonary to systemic flow ratios greater than 2:1 (25/102) had congestive failure and evidence of biventricular dysfunction. Significant tricuspid regurgitation (N = 11) and persistent systemic to pulmonary artery shunts (N = 6) contributed to volume overload and congestive failure in the patients with large residual ventricular septal defect. Isolated severe residual right ventricular outflow tract obstruction was a common cause of chronic CHF. Pulmonary artery hypertension was present in 20/36 patients with CHF. The increased pulmonary pressure was not wholly due to an increased pulmonary flow since 7/20 patients had pulmonary vascular resistance greater than 3 mm Hg/L/min/m2. Our findings indicate that persistent or chronic congestive heart failure in postoperative tetralogy of Fallot patients requires bilateral cardiac catherterization since an identifiable and surgically correctable lesion is nearly always present.
对102例法洛四联症修复术后1至12年连续接受心导管检查的患者，确定了慢性充血性心力衰竭（CHF）的病因。102例患者中有36例观察到慢性CHF。导致充血性心力衰竭的最常见异常（31/36）是单独存在的大的残余室间隔缺损或合并其他病变。所有术后肺循环与体循环血流量比大于2:1的患者（25/102）均出现充血性心力衰竭及双心室功能障碍的证据。严重三尖瓣反流（n = 11）和持续性体肺分流（n = 6）导致了大的残余室间隔缺损患者的容量负荷过重和充血性心力衰竭。孤立的严重残余右心室流出道梗阻是慢性CHF的常见原因。36例CHF患者中有20例存在肺动脉高压。肺压力升高并非完全由于肺血流量增加，因为20例患者中有7例肺血管阻力大于3 mmHg/L/min/m²。我们的研究结果表明，法洛四联症术后患者的持续性或慢性充血性心力衰竭需要进行双侧心导管检查，因为几乎总是存在可识别且可手术纠正的病变。
