The analysis of right ventricular outflow tract procedures for repair of tetralogy of Fallot and postoperative right ventricular function / 中华胸心血管外科杂志

ABSTRACT

Objective To analyze the relation of right ventricular outflow tract (RVOT) procedures for repair of tetralogy of Fallot and postoperative right ventricular function in order to improve the postoperative results at mid-long term follow-up.Methods A total of 125 patients for data collection with repair of TOF between January 2003 and January 2006 were prospectively enrolled in the study.Among them,66 were male and 59 were female.The ages ranged from 1 to 5 (3.4 ± 1.1) years,weight from 7 to 26 (15.2 ± 5.7) kg.20 healthy controls with a similar age and body weight were included.The type of RVOT procedure included transannular patch repair (M1) in 67 patients,patch to infundibulum (M2) in 6 patients,tranright-ventricle (RV) no patch repair (M3) in 18 patients and transatrial-transpulmonary no patch repair (M4) in 34 patients.Doppler echocardiogram and tissue Doppler imaging were performed to evaluate RV function.RV systolic function was evaluatedusing tricuspid annular plane systolic excursion (TAPSE) and index of myocardial performance (MPI).RV diastolic function was evaluatedusing ratio of Em/Am and E/Em.Unvariate and logistic regression analysis were used to identify the affective factors.Results In five years fellow-up,MPI and E/Em were higher in patents with M1 and M2 than those in the patients with M3 and M4.Univariate analysis revealed Nakata index,previous shunt operation,operative techniques、postoperative pulmonary regurgitation and during of QRS as risk factors for MPI.In the multivariate analysis,operative techniques and during of QRS were risk factors for MPI.Univariate analysis revealed Nakata index,operative techniques,PR and during of QRS as risk factors for E/Em.In the multivariate analysis,PR was the risk factor for E/Em.Conclusion RV dysfunction is associated with the type of RVOT procedure,diastolic dysfunction is correlative with postoperative PR and systolic dysfunction is correlative with enlarge of RVOT with patch and during of QRS.Echocardiographic imaging is a simple and reliable method for assessment of RV function after repaired TOF.