Comparison of long-term postoperative sequelae in patients with tetralogy of Fallot versus isolated pulmonic stenosis.
Comparison of long-term postoperative sequelae in patients with tetralogy of Fallot versus isolated pulmonic stenosis.
复制标题
法洛四联症与孤立性肺动脉瓣狭窄患者长期术后后遗症的比较。
DOI：
10.1016/j.amjcard.2014.04.041
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Krasuski,RichardA
中科院分区：
文献类型：
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作者：
Zdradzinski,MichaelJ;Qureshi,AtharM;Stewart,Robert;Pettersson,Gosta;Krasuski,RichardA
完全修复后的法洛四联症（TOF）和外科瓣膜切开术后的肺动脉狭窄（PS）患者通常会发生严重的肺动脉返流（PR），最终需要进行瓣膜置换。尽管TOF患者肺动脉瓣置换术的时机有标准，但何时对瓣膜切开术患者进行干预以及TOF建议是否适用仍不清楚。我们的目的是比较瓣膜切开术治疗PS与完全修复TOF的结构和功能后遗症。我们比较了2005年至2012年期间新转诊至先天性心脏病中心评估PR的109例成人（34例PS和75例TOF）的临床特征、心电图、超声心动图、心脏磁共振成像（MRI）和有创血流动力学。两个队列在基线人口统计学和纽约心脏协会心功能分级方面相似。瓣膜切开术患者通过超声心动图显示的PR程度略高，尽管心脏MRI显示的PR程度相似。TOF患者心电图QRS波宽度较大（114 ± 27 vs 150 ± 28 ms，p <0.001）。TOF患者的MRI右心室射血分数（49 ± 8 vs 41 ± 11%，p = 0.001）和左心室射血分数（59 ± 7 vs 52 ± 10%，p = 0.002）较低。TOF患者的起搏器或除颤器植入率显著较高（3% vs 23%，p = 0.011）。总之，瓣膜切开术和完全修复术后患者的PR程度和症状严重程度相似。双心室收缩功能和心电图QRS宽度似乎受影响较小，这表明TOF的形态学变化及其修复超出了PR的影响。这些研究结果表明，需要为PR瓣膜切开术后患者制定疾病特异性指南。
Patients with tetralogy of Fallot (TOF) after complete repair and pulmonic stenosis (PS) after surgical valvotomy often develop significant pulmonic regurgitation (PR) that eventually requires valve replacement. Although criteria exist for the timing of pulmonary valve replacement in TOF, it remains less clear when to intervene in valvotomy patients and whether TOF recommendations can be applied. Our aim was to compare the structural and functional sequelae of valvotomy for PS with complete repair for TOF. We compared the clinical characteristics, electrocardiograms, echocardiograms, cardiac magnetic resonance imaging (MRI), and invasive hemodynamics of 109 adults (34 PS and 75 TOF) newly referred to a congenital heart disease center for evaluation of PR between 2005 and 2012. Both cohorts were similar in terms of baseline demographics and presenting New York Heart Association function class. Valvotomy patients had a slightly greater degree of PR by echocardiogram, although it was similar by cardiac MRI. Electrocardiography QRS width was greater in patients with TOF (114 ± 27 vs 150 ± 28 ms, p <0.001). MRI right ventricular ejection fraction (49 ± 8 vs 41 ± 11%, p = 0.001) and left ventricular ejection fraction (59 ± 7 vs 52 ± 10%, p = 0.002) were lower in patients with TOF. Pacemaker or defibrillator implantation was significantly greater in patients with TOF (3% vs 23%, p = 0.011). In conclusion, patients postvalvotomy and complete repair present with similar degrees of PR and severity of symptoms. Biventricular systolic function and electrocardiography QRS width appear less affected, suggesting morphologic changes in TOF and its repair that extend beyond the effects of PR. These findings suggest the need for developing disease-specific guidelines for patients with PR postvalvotomy.