초록접수 현황
| 16F-283 | 구연 발표 |
Variations in the Right Ventricular Mechanics after Repair of Tetralogy of Fallot: Right Ventricular Outflow Track Patch Enlargement Versus Conduit Repair
Byung Won Yoo¹, Young Jin Kim², Jae Young Choi³, Lucy Youngmin Eun³, Young Hwan Park⁴, Han Ki Park⁴
¹Department of Clinical Pharmacology, Severance Hospital, Clinical Trial Center, Yonsei University College of Medicine, Seoul, Korea, ²Department of Radiology, Yonsei University College of Medicine, Seoul, Korea, ³Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea, ⁴Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
Background : After TOF repair by right ventricular outflow tract (RVOT) patch enlargement, pulmonary regurgitation leads to progressive RV deterioration. In TOF with pulmonary atresia, conduit regurgitation can occur after RVOT conduit repair, although its impact on the RV has not been well documented.
Methods : A total of 124 patients with RVOT patch enlargement (PR group) and 29 patients with non-valved conduit repair (CR group) were evaluated by cardiac MRI. Correlations among MRI and clinical parameters were investigated. In CR group, the effects of operation-related factors on RV were evaluated.
Results : Although PR or CR fractions were similar between groups, CR group had a smaller RVEDVi. RV volume increased with PR% in PR group but not in CR group. Residual PS was negatively correlated with RV volume, and weakly positively correlated with RV function. Conduit stenosis didn't influence RV volume but was negatively correlated with RV EF (r=-0.54, P=0.003). In CR group, RV pressure after initial repair was negatively correlated with RVEDVi and CR%. Patients with reoperation for conduit replacement had a larger RVEDVi, which was correlated with total CPB time. In multivariate analysis, total CPB time (β=0.11, P=0.038) and RV pressure after initial repair (β=-0.85, P=0.017) were significant predictors of RVEDVi in CR group.
Conclusion : This study showed the variations in RV mechanics between patients with RVOT patch and those with RV-PA conduit for TOF repair. The indications for pulmonary valve implantation for patients with CR should be considered in a different manner than for patients with RVOT patch repair.
Methods : A total of 124 patients with RVOT patch enlargement (PR group) and 29 patients with non-valved conduit repair (CR group) were evaluated by cardiac MRI. Correlations among MRI and clinical parameters were investigated. In CR group, the effects of operation-related factors on RV were evaluated.
Results : Although PR or CR fractions were similar between groups, CR group had a smaller RVEDVi. RV volume increased with PR% in PR group but not in CR group. Residual PS was negatively correlated with RV volume, and weakly positively correlated with RV function. Conduit stenosis didn't influence RV volume but was negatively correlated with RV EF (r=-0.54, P=0.003). In CR group, RV pressure after initial repair was negatively correlated with RVEDVi and CR%. Patients with reoperation for conduit replacement had a larger RVEDVi, which was correlated with total CPB time. In multivariate analysis, total CPB time (β=0.11, P=0.038) and RV pressure after initial repair (β=-0.85, P=0.017) were significant predictors of RVEDVi in CR group.
Conclusion : This study showed the variations in RV mechanics between patients with RVOT patch and those with RV-PA conduit for TOF repair. The indications for pulmonary valve implantation for patients with CR should be considered in a different manner than for patients with RVOT patch repair.
책임저자: Han Ki Park
Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
발표자: Han Ki Park, E-mail : hank@yuhs.ac