法洛四联症根治术后肺动脉瓣返流对近中期疗效的影响分析

The analysis of influence of pulmonary regurgitation after tetralogy of Fallot correction on early and mid-term outcomes

目的探讨法洛四联症(TOF)根治术后肺动脉瓣返流对右心大小及功能、左心功能的影响及肺动脉瓣返流与ECG QRS波宽度的关系。方法选取了2011年3月至2014年5月在解放军总医院心血管外科行TOF根治术的49名患者,复查心脏超声、胸片及ECG,根据肺动脉瓣返流程度分为两组,A组(n=24)包括无肺动脉瓣返流及轻度返流患者,B组(n=25)包括肺动脉瓣中重度返流患者,比较两组患者右室的大小、左室射血分数(LVEF)及ECG QRS波宽度等。结果术后近期及中期B组患者右室扩大指数(RV增I)要大于A组患者,差异有统计学意义(P<0.05),术后近期ECG QRS波宽度在两组之间无统计学差异,但术后中期B组患者ECG QRS波宽度大于A组患者,差异有统计学意义(P<0.05),术后近中期B组患者LVEF要低于A组患者,差异有统计学意义(P<0.05),并且右室舒张末径大小与LVEF呈较弱负相关关系(r=-0.341,P<0.05)。结论 TOF根治术后肺动脉瓣返流会造成右心扩大,是造成术后远期右心功能受损的重要因素,并且对左心功能也有一定影响,肺动脉瓣返流会造成ECG QRS波增宽,右房右室扩张,导致心律失常甚至猝死等。

Objective Correction of tetralogy of Fallot（ TOF） has been underwent in many heart centers,early radical correction of TOF has been in the control of about 1%-2%,but the residual pulmonary regurgitation（ PR） will have adverse influence on prognosis of radial correction of TOF. This study was undertaken to investigate the influence of residual PR on size of right ventricle,right ventricular function,LVEF and the relationship between PR with widen of QRS wave. Methods From March of 2011 to May of2014,50 patients who underwent radical correction of TOF in PLA general hospital were selected,and were all underwent ultrasonic cardiogram,X-ray and electrocardiogram in follow-up period. The patients were divided into two groups according to the degree of pulmonary valve regurgitation,Group A： no PR and mild PR,Group B： moderate and severe PR. The size of RV,LVEF and widen of ORS wave was compared between two groups. Results Group B had a significant bigger RV expansion index than group A（ P〈0.05） in early and mid-term outcomes. The QRS wave had no statistically significant difference in both group in early-term outcomes,but the QRS wave of group B was wider than that of group A in mid-term outcomes（ P〈0.05）. The LVEF between two groups showed statistically significant difference in early and mid-term outcomes（ P〈0.05）,group A had bigger LVEF than group B and there was a weak negative correlation between the size of RV and LVEF. Conclusion Residual pulmonary regurgitation can lead to dilation of RV and it is an important reason for postoperative dysfunction of RV. Residual PR can also have harmful effect on LVEF and widen ORS wave,finally result in arrhythmia and sudden death.