在Fallot的修复四重症中,残留的肺狭窄和右心室收缩性
Yuji Tominaga1,2, Shigemitsu Iwai1, Masaki Taira2
1Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
概括
在Fallot患者的修复四重症中,减少右心室喷射分数 (RVEF) 可以掩盖残留肺狭窄症 (rPS) 的严重程度. 这种掩盖在肺门手术后增加了不良心血管事件.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 儿童心脏病学 儿童心脏病学
背景情况:
- 肺部反 (PR) 在修复的Fallot四重法 (ToF) 中很常见.
- 关于残留肺狭窄症 (rPS) 对肺门手术后的结果对有PR的ToF患者的影响进行了辩论.
- 右心室喷射分数 (RVEF) 可能影响rPS评估.
研究的目的:
- 为了研究rPS对经过修复的ToF患者进行肺门手术的预后的影响,通过RVEF分层.
- 确定RVEF是否会影响评估rPS严重程度和随后的不良事件.
主要方法:
- 这是一项多中心的回顾性研究,对117名经过修复的ToF患者进行了多中心的回顾性研究,这些患者患有中度至重度的PR,接受了肺门手术.
- 根据rPS (PSR) 和RVEF (保留RVEF[pEF]或减少RVEF[rEF]) 的存在,患者被分为四组.
- 分析了临床参数和术后不良事件发生率.
主要成果:
- 在PSR和rEF (PSR-rEF) 组中观察到最低的5年无不良心血管事件.
- 在PSR-rEF组表现出最高的右心室末端透缩压 (RVEDP).
- RVEDP>8 mmHg显著与不良事件的增加有关.
结论:
- 在经过修复的ToF患者中减少的RVEF与PR可能会掩盖rPS的真正严重程度.
- 这种掩盖效应可能导致手术延迟肺干预,并增加心血管不良事件的风险.
- 在这种患者群体中,RVEDP是不良结果的关键指标.
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