法乐氏四联症根治术后心功能的临床评价

目的评价法乐氏四联症(TOF)根治术后心功能的变化并探讨其影响因素。方法对43例TOF患者(TOF组),进行TOF根治术后1～3.5年的随访;并设年龄相仿的自愿健康体检人员21例为对照组。M超声求出左室射血分数(LVEF),用组织多普勒技术(TDI)测定右心室舒张晚期(Aa)及舒张早期(Ea)三尖瓣环的运动速度;测定右室等容收缩时间(ICT)、等容舒张时间(IRT)、等容收缩速度(IVV)、等容收缩加速度(IVA)及右心射血等容时间指数。对21例17岁以上患者行活动平板运动实验。结果TOF组患者的心功能Ea、Aa三尖瓣环的运动速度(11.5cm/s±2.6cm/s、9.6cm/s±1.7cm/s),E/A(1.16±0.36)、IVV(7.7cm/s±1.8cm/s)及IVA(131.7cm/s2±37.6cm/s2)均明显小于对照组(Ea:17.1cm/s±2.4cm/s、Aa:12.9cm/s±2.9cm/s,E/A:1.36±0.26、IVV:9.9cm/s±1.4cm/s,IVA:222.5cm/s2±39.2cm/s2)),ICT、IRT及右心室射血等容时间指数增加;运动耐量显著下降。结论TOF根治术后患者,短期内心功能不能恢复至正常人的水平;对此类患者应严密监测以提高生存质量。

Clinical evaluation of the heart function early after repair of tetralogy of Fallot: follow-up of 43 patients

OBJECTIVE: To evaluate the heart function of the patients early after the repair of tetralogy of Fallot (TOF). METHODS: Forty-three patients with TOF, 25 males and 18 females, underwent operation at the age of 2.5 - 52 years (16.7 years on average) and were followed up for 1 - 3.5 years. Twenty-one age-matched healthy persons were used as controls. Tissue Doppler imaging (TDI) was used to measure the values of the peak tricuspid ring velocity during early diastole (Ea), late diastole (Aa), systole, and isovolumic contraction, and isovolumetric contraction acceleration (IVA); and isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and isovolumetric contraction velocity (IVV) of the right ventricle. Tei index was calculated using the formula: (ICT + IRT)/ET. Treadmill test was used on the patients aged > 17 to measure the maximal heart rate maximal blood pressure, maximal exercise tolerance (MET), and movement time. RESULTS: The peak tricuspid ring velocity during Ea of the repaired TOF group (rTOF group) was 11.5 +/- 2.6 cm/s, significantly lower than that of the control group (17.1 +/- 2.4 cm/s, P < 0.0001), the peak tricuspid ring velocity during Aa of the rTOF group was 9.6 +/- 1.7 cm/s, significantly lower than that of the control group (12.9 +/- 2.9 cm/s, P < 0.001), the E/A of the rTOF group was 1.16 +/- 0.36, significantly lower than that of the control group (1.36 +/- 0.26, P < 0.05). The IVV of the rTOF group was 7.7 +/- 1.8 cm/s, significantly lower than that of the control group (9.9 +/- 1.4 cm/s, P = 0.0030, and the IVA of the rTOF group was 131.7 +/- 37.6 cm/s(2), significantly lower than that of the control group (222.5 +/- 39.2 cm/s(2), P < 0.001). The Tei index of the rTOF group was 0.58 +/- 0.11, significantly higher than that of the control group (0.52 +/- 0.04, P = 0.029). The maximal heart rate maximal blood pressure, MET, and movement time of the rTOF group were all significantly lower than those of the control group (P < 0.05 or P < 0.01). CONCLUSION: The heart function of the patients undergoing repair of TOF fails to recover to the normal level during a short time after the surgery.