法乐四联症术后肺动脉反流对右心功能的影响

Correlation between pulmonary regurgitation and right ventricular function in patients with repaired tetralogy of fallot

目的分析肺动脉反流与RVEDV、RVESV、RVEF等右心室功能指标的相关程度以及探讨肺动脉反流的治疗措施。方法应用mMRI技术测定58例TOF术后的PRF、RVEDVI、RVESVI、RVEF、SVI，应用线性回归分析PRF与右心功能指标之间的相关性。对于RVEF％45％的病例给予口服强心利尿药物，3个月后随访mMRI，比较服药前后右心功能的变化。结果RVEDVI与PRF存在正相关，r值为0．700RVESVI与PRF正相关，r值为0．685；RVEF与PRF负相关，r值为-0．523；SVI与PRF相关性较弱，r值为0．334。口服强心利尿剂3个月后有8例接受了第二次C—MRI检查，RVESVI由（76．5±22．5）ml／m^2减小至（71．3±21．2）ml／m^2（P〈0.01），RVEF由（33．1±7．0）％上升至（37．9±6．8）％（P〈0．05）；RVEDVI，PRF无统计学差异（P值为0．650，0．326）。结论TOF术后肺动脉反流可造成右心室容积的扩大和心功能的降低，口服强心利尿药物并不能改善肺动脉反流，可根据RVEDV掌握准确的PVR时机。

Objective To analyze the correlation between pulmonary regurgitation （PR） and right ventricular function in the patients with repaired tetralogy of fallot （TOF）. Methods Fifty eight patients with repaired TOF were enrolled in this study. Pulmonary regurgitation fraction （PRF）, right ventricular end-diastolic volume index （RVEDVI）, right ventricular end-systolic volume index （RVESVI） and stroke volume index （SVI） were assessed using cardiac-MaRk Linear regression analysis was applied to analyze the correlation between PRF and RVEDVI, RVESVI, SVI. The patients whose RVEFIs were less than 45% were treated with digoxin, frusemide and spironolactone to improve the heart function; and 3 months later, their right ventricular function was reassessed using cardiac-MRl. Results Linear regression analysis revealed a positive correlation between PRF and RVED-VI （r = 0. 700）, a positive correlation between PRF and RVESVI （r = 0. 685）, and a negative correlation between PRF and RVEF （r = - 0. 523）. The correlation between SVI and PRF was weak （r = 0. 334）. In the 8 patients treated with 3 months medications, their RVESVIs were significantly decreased from （76. 5 ± 22. 5）ml/m^2 to （71.3 ± 21.2）ml/m^2 （P〈0. 01） ; their RVEFs were significantly increased from （33.1 ± 7. 0） % to （37. 9 ± 6. 8） % （P〈0. 05） ; RVEDVI and PRF remained unchanged （P = 0. 650, 0. 326）. Conclusions In the patients with repaired TOF, PR can cause RV enlargement and RVEF decreasing. Cardiotonic and diuretic medication can not lessen PR.