法洛氏四联症修复后右室流出道的生长:一项纵向 CMR 研究

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-06-01 Epub Date: 2024-01-10 DOI:10.1016/j.jocmr.2023.100002
Kelsey Jurow, Kimberlee Gauvreau, Nicola Maschietto, Ashwin Prakash
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引用次数: 0

摘要

背景:许多经修复的法洛氏四联症患者因严重的肺动脉反流(PR)而需要进行肺动脉瓣置换术(PVR)。经导管肺动脉瓣置换术(TPVR)是一种与手术肺动脉瓣置换术同样有效且创伤更小的替代方法,但许多原发性右室流出道(RVOT)过大,在转诊时不适合进行 TPVR。了解 RVOT 的生长速度有助于优化转诊时机。本研究旨在检查修复后 TOF 的原发性 RVOT 随时间的纵向生长情况:方法:对121例修复型TOF和原发性RVOT患者(首次CMR检查的中位年龄为14.7岁,首次和最后一次CMR检查的平均间隔时间为8.1年)的序列心脏磁共振成像(CMR)数据进行回顾性回顾,测量RVOT直径、横截面积、周径和长度的序列变化:随着年龄的增长,RVOT的所有参数都在持续增长,但在TOF修复术后的10年中增长更为迅速(就最小收缩期直径而言,在第12年之前每10年平均增长5.7毫米,之后每10年增长2.3毫米)。经环补片和无肺动脉狭窄患者的 RVOT 更大(p
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Growth of the right ventricular outflow tract in repaired tetralogy of Fallot: A longitudinal CMR study.

Background: Many patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR) due to significant pulmonary regurgitation (PR). Transcatheter PVR (TPVR) is an equally effective and less invasive alternative to surgical PVR but many native right ventricular outflow tracts (RVOTs) are too large for TPVR at time of referral. Understanding the rate of growth of the RVOT may help optimize timing of referral. This study aims to examine the longitudinal growth of the native RVOT over time in repaired tetralogy of Fallot (TOF).

Methods: A retrospective review of serial cardiac MRI cardiovascular magnetic resonance (CMR) data from 121 patients with repaired TOF and a native RVOT (median age at first CMR 14.7 years, average interval between the first and last CMR of 8.1 years) was performed to measure serial changes in RVOT diameter, cross-sectional area, perimeter-derived diameter, and length.

Results: All parameters of RVOT size continued to grow with increasing age but growth was more rapid in the decade after TOF repair (for minimum systolic diameter, mean increase of 5.7 mm per 10 years up to year 12, subsequently 2.3 mm per 10 years). The RVOT was larger with a transannular patch and in patients without pulmonary stenosis (p < 0.001 for both), but this was not associated with rate of growth. More rapid RVOT enlargement was noted in patients with larger right ventricular end-diastolic volume (RVEDV), higher PR fraction, and greater rates of increases in RVEDV and PR (p < 0.001 for all) CONCLUSIONS: in patients with repaired TOF, using serial CMR data, we found that RVOT size increased progressively at all ages, but the rate was more rapid in the first decade after repair. More rapid RVOT enlargement was noted in patients with a larger RV, more PR, and greater rates of increases in RV size and PR severity. These results may be important in considering timing of referral for transcatheter pulmonary valves, in planning transcatheter and surgical valve replacement, and in designing future valves for the native RVOT.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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