Characterization of Anatomic Ventricular Tachycardia Isthmus Pathology After Surgical Repair of Tetralogy of Fallot
Characterization of Anatomic Ventricular Tachycardia Isthmus Pathology After Surgical Repair of Tetralogy of Fallot
复制标题
法洛四联症手术修复后室性心动过速峡部病理的解剖学特征
DOI：
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
M. Fishbein
中科院分区：
文献类型：
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作者：
J. Moore;A. Seki;K. Shannon;R. Mandapati;R. Tung;M. Fishbein
背景-尽管导管消融术已被用于治疗法洛四联症折返性单形性室性心动过速的关键峡部，但这些区域的解剖学和组织学特征尚未完全确定。通过对法洛四联症心脏的尸检来明确其病理基础。方法和结果：对27例诊断为法洛四联症的心脏进行了检查。解剖学定义的峡部包括（1A）心室切开术-三尖瓣环，（1B）心室切开术-室间隔缺损补片，（2）心室切开术-肺动脉瓣环，（3）肺动脉瓣环-室间隔缺损补片，和（4）室间隔缺损补片-三尖瓣环。测量所有标本的长度和壁厚，并对手术存活的标本进行光学显微镜检查。对于死亡时年龄≥5岁的受试者，88%存在峡部1A和1B，25%存在峡部2，94%存在峡部3，13%存在峡部4。峡部1A的尺寸最大，（平均长度，3.9±1.08;厚度，1.5±0.3 cm），峡部1B中间尺寸（平均长度，2.4±0.8;厚度，1.1±0.4 cm），峡部2、3和4为最小尺寸（平均长度分别为1.5±0.5、1.4±0.8和0.6±0.4 cm;厚度分别为0.5±0.2、0.6±0.2和0.3±0.04 cm）。组织学检查（n=7）显示，与非峡部对照组相比，解剖峡部纤维化增加。结论--在法洛四联症修复患者中发现峡部尺寸和组织学的一致性。峡部1A与最大的形态尺寸相关，而附近新描述的峡部1B明显较小。在具有最小尺寸的峡部中，峡部3是最常见的。
Background— Although catheter ablation has been used to target the critical isthmuses for re-entrant monomorphic ventricular tachycardia in tetralogy of Fallot, the anatomy and histology of these regions have not been fully characterized. Autopsy hearts with tetralogy of Fallot were evaluated to clarify the pathological substrate. Methods and Results— Twenty-seven hearts with the diagnosis of tetralogy of Fallot were examined. Anatomically defined isthmuses included (1A) ventriculotomy-to-tricuspid annulus, (1B) ventriculotomy-to-ventricular septal defect patch, (2) ventriculotomy-to-pulmonary annulus, (3) pulmonary annulus-to-ventricular septal defect patch, and (4) ventricular septal defect patch-to-tricuspid annulus. Length and wall thickness were measured for all specimens, and light microscopy was performed for those surviving surgery. For subjects ≥5 years at death, isthmuses 1A and 1B were present in 88%, isthmus 2 in 25%, isthmus 3 in 94%, and isthmus 4 in 13%. Isthmus 1A had the greatest dimensions (mean length, 3.9±1.08; thickness, 1.5±0.3 cm), isthmus 1B intermediate dimensions (mean length, 2.4±0.8; thickness, 1.1±0.4 cm), and isthmuses 2, 3, and 4 the smallest dimensions (mean length, 1.5±0.5, 1.4±0.8, and 0.6±0.4 cm; thickness, 0.5±0.2, 0.6±0.2, and 0.3±0.04 cm, respectively). Histological examination (n=7) revealed increased fibrosis in anatomic isthmuses relative to nonisthmus controls. Conclusions— Consistencies in isthmus dimensions and histology are found among patients with repaired tetralogy of Fallot. Isthmus 1A is associated with the largest morphological dimensions, whereas the nearby newly described isthmus 1B is significantly smaller. Of isthmuses with the smallest dimensions, isthmus 3 is the most common.