Background

Right ventricular (RV) dysfunction is associated with adverse long-term outcomes in patients with tetralogy of Fallot. Little is known about RV function in the first years after surgical repair. The aim of this study was to investigate perioperative changes in myocardial deformation using global longitudinal strain.

Methods

A retrospective analysis of patients with surgically repaired tetralogy of Fallot was performed. Global longitudinal peak systolic RV strain was measured on early postoperative echocardiograms, two subsequent postoperative echocardiograms through 2 years postoperatively, and preoperative echocardiograms, when available. Preoperative and late follow-up strain was compared with strain in 0- to 8-month-old and 1- to 4-year-old control subjects, respectively.

Results

Forty-seven patients were included. Compared with postoperative strain (7 ± 7 days postoperatively), strain at follow-up 1 (8.3 ± 4 months postoperatively) was significantly improved (−12.3 ± 3.3% vs −18.8 ± 2.5%, P < .001), with no additional improvement 23.2 ± 6 months postoperatively (−18.8 ± 2.5% vs −19.8 ± 3.1%, P = .12). Postoperative strain was worse than preoperative strain (n = 25, −12.5 ± 3.6% vs −18.4 ± 2.9%, P < .001). Compared with control subjects, preoperative strain was similar (−19.3 ± 3.8% vs −18.4 ± 2.9%, P = .30), though late follow-up strain was significantly worse (−27.7 ± 2.8% vs −19.8 ± 3.1%, P < .001).

Conclusions

RV global longitudinal strain worsens in the early postoperative period following surgical repair of tetralogy of Fallot but recovers through 2 postoperative years. Despite recovery to preoperative values, the presence of RV dysfunction compared with control subjects suggests that long-term dysfunction may begin early. The trajectory of RV dysfunction through the later years needs further study.

中文翻译：

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手术修复后最初几年中法洛氏四联症右心室功能的纵向变化

背景

法洛氏四联症患者的右心室（RV）功能障碍与不良的长期预后相关。在手术修复后的最初几年，对RV功能的了解甚少。这项研究的目的是调查围手术期使用整体纵向应变的心肌变形的变化。

方法

回顾性分析法罗氏四联症手术修复的患者。在术后早期超声心动图，术后两年至术后两年的两个后续术后超声心动图以及术前超声心动图上测量总体纵向收缩期右室RV应变。分别比较了术前和晚期随访菌株与0至8个月大和1至4岁大对照组的应变。

结果

包括四十七名患者。与术后应变（术后7±7天）相比，随访1（术后8.3±4个月）的应变显着改善（−12.3±3.3％vs -18.8±2.5％，P  <.001），没有其他增加术后23.2±6个月改善（-18.8±2.5％vs -19.8±3.1％，P  = 0.12）。术后应变比术前应变差（n  = 25，−12.5±3.6％vs −18.4±2.9％，P  <.001）。与对照组相比，术前劳损相似（−19.3±3.8％vs −18.4±2.9％，P  = 0.30），但晚期随访劳损明显较差（−27.7±2.8％vs −19.8±3.1％，P  <.001）。

结论

在对法洛氏四联症进行手术修复后，RV总体纵向应变在术后早期恶化，但在术后2年内恢复。尽管恢复到术前值，但与对照组相比，RV功能障碍的存在提示长期功能障碍可能较早开始。RV功能障碍的轨迹，直到以后的几年需要进一步研究。