Helbing W A, Niezen R A, Le Cessie S, van der Geest R J, Ottenkamp J, de Roos A
Department of Pediatrics (Division of Pediatric Cardiology), Leiden University, The Netherlands.
J Am Coll Cardiol. 1996 Dec;28(7):1827-35. doi: 10.1016/S0735-1097(96)00387-7.
We sought to assess right ventricular diastolic function in young patients with corrected tetralogy of Fallot and pulmonary regurgitation.
Pulmonary regurgitation is an important problem in repair of tetralogy of Fallot. Its effects on right ventricular diastolic function in children are unknown.
Nineteen children with repair of tetralogy of Fallot (mean age [+/- SD] 12 +/- 3 years, mean age at operation 1.5 +/- 1) and 12 healthy children were studied. Summation of magnetic resonance velocity mapping pulmonary and tricuspid volume flow curves provided right ventricular time-volume curves. Ventricular size was assessed with tomographic magnetic resonance imaging (MRI). Graded exercise testing was performed.
Systematic and random differences (mean +/- SD) of velocity mapping and Doppler tricuspid time to peak velocities (peak E: 1 +/- 26 ms, r = 0.43; peak A: 2 +/- 11 ms, r = 0.76), E/A ratio (0.04 +/- 0.5, r = 0.63) and duration of pulmonary regurgitation (20 +/- 35 ms, r = 0.74) were satisfactory. In 6 patients (group I), late diastolic forward pulmonary artery flow was absent; in 13 patients (group II), this flow contributed 1% to 14% to right ventricular stroke volume. Significant differences were increased deceleration time (315 +/- 91 vs. 168 +/- 28 ms, p < 0.001), decreased filling fraction (44 +/- 11 vs. 55 +/- 16%, p = 0.02) and increased peak early filling rate (378 +/- 124 vs. 286 +/- 112 ml/s, p = 0.018) between control subjects and group I, and increased deceleration time (230 +/- 40, p = 0.03) between control subjects and group II. Pulmonary regurgitation, ventricular size and ejection fraction did not differ significantly between patient groups. Exercise function was diminished with restrictive right ventricular physiology (p < 0.001, group II vs. control subjects).
Impaired relaxation and restriction to filling affect right ventricular function in children with repair of tetralogy of Fallot and pulmonary regurgitation. Restrictive right ventricular physiology is associated with decreased exercise function.
我们试图评估法洛四联症矫正术后合并肺动脉反流的年轻患者的右心室舒张功能。
肺动脉反流是法洛四联症修复术中的一个重要问题。其对儿童右心室舒张功能的影响尚不清楚。
研究了19例法洛四联症修复术后的儿童（平均年龄[±标准差]12±3岁，平均手术年龄1.5±1岁）和12例健康儿童。磁共振速度映射肺动脉和三尖瓣容积流量曲线的总和提供了右心室时间-容积曲线。通过断层磁共振成像（MRI）评估心室大小。进行分级运动试验。
速度映射和多普勒三尖瓣达到峰值速度的时间（E峰：1±26毫秒，r = 0.43；A峰：2±11毫秒，r = 0.76）、E/A比值（0.04±0.5，r = 0.63）以及肺动脉反流持续时间（20±35毫秒，r = 0.74）的系统和随机差异（平均值±标准差）令人满意。6例患者（I组）舒张晚期肺动脉前向血流消失；13例患者（II组），该血流对右心室搏出量的贡献为1%至14%。对照组与I组之间，减速时间显著延长（315±91 vs. 168±28毫秒，p < 0.001）、充盈分数降低（44±11 vs. 55±16%，p = 0.02）以及早期充盈峰值速率增加（378±124 vs. 286±112毫升/秒，p = 0.018）；对照组与II组之间，减速时间延长（230±40，p = 0.03）。患者组之间的肺动脉反流、心室大小和射血分数无显著差异。右心室限制性生理状态下运动功能受损（p < 0.001，II组与对照组相比）。
舒张功能受损和充盈受限影响法洛四联症矫正术后合并肺动脉反流儿童的右心室功能。右心室限制性生理状态与运动功能降低有关。
