法乐四联症矫治手术前后心功能及心腔几何构型的变化

Changes of cardiac function before and after surgical rectifying in patients with tetralogy of fallot

目的探讨法乐四联症(TOF)矫治手术前后及随访中左、右心室功能及左心房收缩功能的变化。方法选择在我院成功施行TOF矫治手术治疗的85例TOF患者为研究对象。所有患者于手术前、术后1周及术后12个月行超声心动图检查。以左、右心室及左心房容积变化及射血分数作为左、右心室收缩功能的指标;以左心房射血分数(LAEF)及左室晚期充盈分数(AFF)作为反映左房收缩功能的指标;以左室偏心率及长径/短径比值作为反映左室几何构型的变化。结果TOF矫治手术后,左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)增大,右室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)及右室射血分数(RVEF)均减小;LAEF及AFF亦增大。LVEF、LAEF和AFF在随访中持续改善,RVEDV、RVESV、RVEF随访中进一步减少。结论TOF矫治手术既减轻了右室的容量负荷,又改善了左室、左心房的收缩功能及几何构型。在随访中,左室功能持续改善,右室功能维持于正常水平。

Objective To evaluate the changes of left, right ventricular （LV） volume and function and left atrial （LA） contraction function before and after surgical rectifying in patients with tetralogy of fallot（TOF）. Methods 85 patients with TOF underwent echocardiographic examination 1 week before and after, and 12 months after surgical rectifying. Left and right ventricularr end-systolic volume （RVESV, LVESV）, left and right ventricularr end- diastolic volume （RVEDV, LVEDV） and left and right ejection fraction （LVEF, RVEF） which were as the assessment of the right and left ventricular function, left atrial filling fraction （AFF） and LA ejection fraction （LAEF） which reflected left atrial contraction function were measured and calculated. The change of LV geometry was reflected from LV eccentricity. Results After surgical rectifying, LVEDV, LVESV, LVEF and LAEF were significantly increased while RVEDV, RVESV and RVEF were significantly reduced; LV eccentricity were significantly decreased, suggesting the presence of an improvement of LV preload, LV geometry and function During follow-up, the improvements of LV function and geometry were maintained. RVEDV, RVESV and RVEF decreased significantly, RVEDV, RVESV, AFF, LVEF and LAEF were changed significantly. Conclusion Surgical rectifying TOF not only decreases the preload of right ventricle, but also significantly improves LV systolic function and geometry. During follow-up, the improvement of LVEF and LAEF can be maintained while the RVEF was stable on normal level.