Abstract
Objective. To evaluate systolic and diastolic myocardial function of both ventricles in infants with Fallot's tetrad by
methods of spectral and tissue Doppler sonography before and after radical correction of the defect during the postoperative
period.
Material and methods. The prospective analysis was made in 50 infants with Fallot's tetrad. The primary radical
correction was performed in 37 patients. The age of patients in average was 21.6±9.2 months.
The controls included 25 somatically healthy children of the same age category (the average age was 24.4±6.7
months). The value of systolic and diastolic function was performed with spectral and tissue Doppler sonography
and based on deformation and excursion of annulus fibrosis of mitral and tricuspid valves. The postoperative period
was valued according to the length of mechanical ventilation of lungs and intensive therapy, factor score of
inotropic support.
Results. Neither systolic function of the left ventricle nor the right ventricle determined the character of postoperative
period, despite of the reducing tendency after radical correction. The presence of restrictive type of diastolic dysfunction
of the right ventricle significantly increased time for mechanical ventilation, inotropic support, stay in
intensive care unit and the magnitude of transudation from serous sacs in patients with Fallot's tetrad.
The association of initial myocardium movement amplitude of the right ventricle free wall into the phase of the late
diastole with the magnitude of transudation from serous sacs in early postoperative period (r=0.45, p=0.025) was indicated.
Also the tendency to the association for this index with respiratory therapy demand was (r=0.323, p=0.124).
The baseline values for relative instant left ventricle stiffness into the early diastole were in direct association with
intensive therapy demand (r=0.382, p=0.065) and transudation volume (r=0.5, p=0.013) after radical correction.
Conclusions. It`s necessary to use a combination of various ultrasound methods of diagnostic to evaluate myocardial
function adequately. The diastolic dysfunction in restrictive type and the coefficient for relative instant ventricle
stiffness of heart more than 1 could be predictive factors for complicated postoperative period and indication for
systemic-pulmonary anastomosis on the first stage of treatment.
References
Бокерия, Л. А. Анализ ближайших результатов хирургического лечения тетрады Фалло у детей раннего возраста / Л. А. Бокерия, М. Р. Туманян, М. А. Зеленикин и др. // Грудная и серд.-сосуд. хир. - 2001. - № 1. - С. 4-8.
Зеленикин, М. А. Влияние системно-легочного анастомоза на результаты радикальной коррекции тетрады Фалло у больных раннего возраста / М. А. Зеленикин, С. Ю. Прасолов, Т. И. Мусатова и др. // Грудная и серд.-сосуд. хир. - 1997. - № 2. - С. 27.
Подзолков, В. П. Варианты течения госпитального периода у больных после радикальной коррекции тетрады Фалло: клиника, диагностика и результаты лечения осложнений / В. П. Подзолков, В. Н. Шведунова, Е. В. Злочевская и др. // Анналы хир. - 2004. - № 1. - С. 28-36.
Прасолов, С. Ю. Выбор подходов к хирургическому лечению больных раннего возраста с тетрадой Фалло: автореф. дис.
Рыбакова, М. К. Комплексная эхокардиографическая оценка систолической и диастолической функции левого и правого желудочков в норме / М. К. Рыбакова, В. В. Митьков, М. Л. Платова // Ультразвуковая и функциональная диагностика. - 2004. - № 45. - С. 48-56.
Ткаченко, С. Б. Тканевое допплеровское исследование миокарда / С. Б. Ткаченко, Н. Ф. Берестень. - М.: Реал-тайм, 2006. - С. 30-44
Dokainish, H. Usefulness of right ventricular tissue Doppler imaging to predict outcome in left ventricular heart failure independent of left ventricular diastolic function / H. Dokainish, R. Sengupta, R. Patel et al. // Am. J. Cardiol. - 2007. - Vol. 99. - Р. 961-965.
Frigiola, A. Pulmonary regurgitation is an important determinant of RV contractile function in patients with surgically repaired tetralogy of Fallot // A. Frigiola, S. Cullen, A. Redington et al. // Circulation. - 2004. - Vol. 110. - P. 153-157.
Gatzoulis, M. Risk factors for arrhythmia and sudden cardiac death later after repair of tetralogy of Fallot: A multicentre study / M. Gatzoulis, S. Balaji, S. Webber et al. // Lancet. - 2000. - Vol. 356. - P. 975-981
Ghai, A. Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot / A. Ghai, C. Silversides, L. Harris et al. // J. Am. Coll. Cardiol. - 2002. - Vol. 40. - P. 1675-1680.
Hsiao, S. Severe tricuspid regurgitation shows significant impact in the relationship among peak systolic tricuspid annular velocity, tricuspid annular plane systolic excursion, and right ventricular ejection fraction / S. Hsiao, S. Lin, W. Wang et al. // J. Am. Soc. Echocardiogr. - 2006. - Vol. 19. - P. 902-910.
Lytrivi, I. Color Doppler Tissue Imaging for Evaluation of right ventricular function in patients with congenital heart disease / I. Lytrivi, W. Lai, H. Ko et al. // J. Am. Soc. Echocardiogr. - 2005. - Vol. 18. - P. 1099-1104.
Therrien, J. Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair / J. Therrien, Y. Provost, N. Merchant et al. // Am. J. Cardiol. - 2005. - Vol. 95. - P. 779-782.
Wernovsky, G. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest / G. Wernovsky, D. Wypij, R. A. Jonas et al. // Circulation. - 1995. - Vol. 92. - P. 2226-2235.
