Pulmonary Regurgitation And Right Ventricular Function In Repaired TOF With Cine-MRI Analysis

PartⅠC-MRI assessment of pulmonary regurgitation in repaired TOFObjective:To assess pulmonary regurgitation in repaired TOF with c-MRI and to analyze the factor related severe pulmonary regurgitation.Method:58 patients who underwent TOF repair from Jan 1996 to Jun 2007 accept c-MRI examination for PRF.All cases are divided into two groups according to PRF＜35%and PRF≥35%.SPSS11.5 software was used to analyze the relationship between PRF and the factors including operation age,gender,weight,the way of RVOT reconstruction,preoperative NAKATA index,McGoon index,duration of CPB, aorta clamping,mechanical support,ICU stay and followup,current NAKATA index, current McGoon index,PALResults:PRF is(25.9+15.2)%,univariate analysis shows that the way of RVOT reconstruction,current NAKATA index,current McGoon index,PAI have statistical significance.Binary Logistic analysis shows that current NAKATA index and PAI are independent factor related with severe PR.Conclusion:Severe PR maybe correlate with the way of transannular enlarging RVOT,related with currently hypoplastic pulmonary arteries and high PAI.And the ratio(Dr~2+Dl~2) /PAD2 has significantly negative relationship with PR.PartⅡComparison of RT-3DE with c-MRI in the assessment of right ventricular function of repaired TOFObjective:To evaluate the accuracy of RT-3DE for measurements of RV function compared to c-MRI,and assess current RV function in repaired TOF.Method:37 randomly selected patients from 58 cases with repaired TOF are underwent both RT-3DE and c-MRI for the data of RVEDV,RVESV,RVEF.We compare them for the difference.30 healthy children are selected as controls.58 patients with repaired TOF are compared to the controls in RV function with c-MRI. with normal group,RVEDVI and RVESVI of repaired TOFs increase(91.9±28.5 vs 67.4±13.2,47.2±22.4 vs 30.5±6.0),RVEF is near normal(51.9%±11.8 vs 54.2%±5.6).Conclusion:RVEF with RT-3DE can be assessed with acceptable accuracy,but it is less good for RVEDV and RVESV.Comparison with normal children,RV volume increases and RVEF is similar.PartⅢImpact of PR on RV function in repaired TOFObjective:To indentify the possibility of PR inducing enlarged RV volume and decreased RVEF,to explore the way to prevent current condition aggravated.Method:PRF,RVEDV,RVESV and SV are measured with c-MRI in 58 patients with repaired TOF.Linear analysis is applied to assess the correlation between PRF and RVEDVI,RVESVI,SVI.The patients whose RVEF＜45%take the medicine including digoxin,frusemide and spironolactone.Three months later the patients are examed with c-MRI again for RVEDV,RVESV,RVEF.Results:Correlation for PRF and RVEDVI,RVESVI,RVEF is r= 0.700, 0.685,-0.523(p＜0.01).After medicine therapy,RVESVI decreases from(76.5±22.5)ml/m~2 to(71.3±21.2) ml/m~2(P＜0.01),RVEF increases from(33.1±7.0)%to (37.9±6.8)%(p＜0.05),but RVEDVI and PRF unchange(p=0.650,0.326)Conclusion:PR can cause RV volume increasing and RVEF decreasing.Oral medicine can not improve PR.We can grasp the suitable timing for PVR according to...