Norgård G, Gatzoulis M A, Moraes F, Lincoln C, Shore D F, Shinebourne E A, Redington A N
Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.
Circulation. 1996 Dec 15;94(12):3276-80. doi: 10.1161/01.cir.94.12.3276.
Restrictive right ventricular (RV) physiology can be present early and late after tetralogy of Fallot repair. It is associated with a complicated early postoperative course but is favorable late after repair because it is associated with less pulmonary regurgitation, better exercise tolerance, and less QRS prolongation and symptomatic ventricular arrhythmias. It is not known, however, whether in the current surgical era, this physiology is present in tetralogy of Fallot patients at mid-term follow-up and whether it is related to the type of RV outflow tract repair. Finally, the impact of this physiology on the early evolution of QRS prolongation has not been examined previously. In this study we attempted to address these issues in a cohort of recently operated patients.
Ninety-five patients were studied 4.3 years after repair by Doppler echocardiography, serial electrocardiograms, and chest radiographs. Restrictive RV physiology defined by the presence of antegrade pulmonary artery flow in late diastole was present in 38% of the patients. It was more common in patients with transannular patch (TAP) repair compared with non-TAP repair (50% versus 21%, P < .05). QRS duration at follow-up was 121.2 +/- 17.6 and 132.6 +/- 11.8 ms in restrictive and nonrestrictive patients with TAP repair, respectively (P < .02).
Restrictive RV physiology has been identified at mid-term follow-up in a contemporary surgical series. It is associated with less QRS prolongation, regardless of the technique used for outflow tract repair, and may be associated with fewer long-term complications. Nonrestrictive physiology is associated with the most marked QRS prolongation. This subgroup is most at risk from the late deleterious consequences of chronic pulmonary regurgitation.
法洛四联症修复术后早期和晚期均可出现限制性右心室（RV）生理改变。它与术后早期病程复杂相关，但修复术后晚期情况较好，因为它与较少的肺反流、更好的运动耐量、较少的QRS波增宽及症状性室性心律失常有关。然而，在当前的手术时代，法洛四联症患者在中期随访时是否存在这种生理改变，以及它是否与右心室流出道修复类型有关，尚不清楚。最后，这种生理改变对QRS波增宽早期演变的影响此前尚未得到研究。在本研究中，我们试图在一组近期接受手术的患者中解决这些问题。
通过多普勒超声心动图、系列心电图和胸部X线片对95例患者在修复术后4.3年进行了研究。舒张期末期存在肺动脉前向血流定义的限制性右心室生理改变在38%的患者中出现。与非经肺动脉环补片（TAP）修复相比，经肺动脉环补片修复的患者中更常见（50%对21%，P<.05）。在接受TAP修复的限制性和非限制性患者中，随访时的QRS波时限分别为121.2±17.6和132.6±11.8毫秒（P<.02）。
在当代手术系列的中期随访中发现了限制性右心室生理改变。无论采用何种流出道修复技术，它都与较少的QRS波增宽相关，并且可能与较少的长期并发症有关。非限制性生理改变与最明显的QRS波增宽相关。该亚组最易受到慢性肺反流晚期有害后果的影响。
