超声心动图评估法洛四联症术后中远期疗效109例随访

目的：运用超声心动图评价法洛四联症手术后的中远期疗效。方法：从1994年1月至2000年2月共109例法洛四联症手术病例，男性81例，女性28例，年龄5－158月，体重6－43kg。一期根治105例，二期根治4例（首期采用右室流出道跨瓣补片）。79例行右室流出道跨瓣补片，2例采用人造血管连接右心室与肺动脉，其余病例行右室流出道不跨瓣补片。术后超声心动图随1-72月。结果：术后残余分流20例（18．3％），70％的残余室间隔缺损直径为0．1－0．2cm，不引起左半心内径增大，但有1例发生细菌性心内膜炎。术后残余右室流出道梗阻2例（1．8％）。肺动脉瓣返流85例（77．9％），返流组右心室扩大率显著高于无返流组（92．9％vs20．8％，P＜0．001）.4例二期根治患者中有3例首期术后出现肺动脉高压。结论：法洛四联症结术后总体中远期疗效满意。较高的肺动脉瓣返流率值得引起重视。对残余分流和姑息术后的病例应加强随访。

Evaluation of the Midterm and Long Term Results of Surgical Repair for Tetralogy of Fallot by Echocardiography:109 Cases Followed Up

To evaluate the midterm and long term results of surgical repair for tetralogy of Fallot by echocardiography. Methods :From January 1994 to February 2000,109 postoperative cases with tetralogy of Fallot were investigated. There were 81 male and 28 female with age 5～158 months and weight 6～43kg. One-staged repair was done in 105 cases and the remained 4 underwent two-staged repair in which only a transannular patch was given in the initial stage. Right ventricular outflow tract reconstruction contained transannular patch in 79,right ventricular outflow patch in 28 and artificial conduit in 2. The follow-up time by echocardiography was 1～72 months. Results:The Postoperative residual shunt occurred in 20(18. 3 % ). Although the diameter of the residual VSD was 0. 1 ～0. 2cm in 70% and had no left-sided heart dilation,there was bacterial endocarditis occurred in one case. Residual obstruction occurred in 2 (1.8 % ). Pulmonary regurgitation occurred in 85 (77.9 % ) of which the occurrence of right ventricular dilation was significantly higher than those without pulmonary regurgitation (92.9 % vs 20. 8 %, P＜0. 001). In follow-up period ,pulmonary hypertension occurred in three of the four cases after the initial procedure. Conclusions:The midterm and long term results of surgical repair of tetralogy of Fallot are generally satisfied. Relative high occurrence of pulmonary regurgitation deserves to be further investigated. Intensive surveillance is advocated in cases with residual shunt or having undergone palliative procedures.