Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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10.18869/acadpub.tumj
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jalali
1390
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ارزیابی نتایج میان مدت جراحی تعویض دریچه پولمونر در بیماران با سابقه جراحی ترمیم کامل تترالوژی فالو در مرکز قلب و عروق شهید رجایی تهران، ایران
Mid-term results of pulmonary valve replacement in patients with total correction of Tetralogy of Fallot in Rajaei Heart Center, Tehran, Iran
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<p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">زمینه و هدف</span></strong><span style="font-size: 10pt">:</span><em><span style="font-size: 10pt"> </span></em><span style="font-size: 10pt">بیماری تترالوژی فالو یکی از
شایعترین بیماریهای مادرزادی سیانوتیک قلب میباشد و امروزه با بهبود روشهای
نوین جراحی این بیماران به سنین بزرگسالی رسیده اما تعداد بسیاری از آنها دچار
عوارض گوناگون میشوند. هدف ما بررسی نتایج میانمدت جراحی ترکیبی اصلاح تترالوژی
فالو و تعویض دریچه پولمونر و ارتباط آن با طول مدت </span><span style="font-size: 7pt">QRS</span><span style="font-size: 10pt"> و نتایج </span><span style="font-size: 7pt">MRI</span><span style="font-size: 10pt"> قبل از
عمل بیماران میباشد.</span><span style="font-size: 9pt"> <br></span></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><span style="font-size: 9pt"></span><b><span style="font-size: 10pt">روش بررسی:</span></b><span style="font-size: 10pt"> 51 بیمار که تحت
جراحی اصلاح کامل تترالوژی و تعویض دریچه پولمونر قرار گرفتند اطلاعات اولیه،
نتایج </span><span style="font-size: 7pt">MRI</span><span style="font-size: 10pt"> قلبی و طول زمان موج </span><span style="font-size: 7pt">QRS</span><span style="font-size: 10pt"> قبل و شش ماه پس از جراحی محاسبه گردید و
کلاس عملکردی بیماران </span><span style="font-size: 7pt">(FC)</span><span style="font-size: 10pt"> <span lang="FA">نیز قبل و پس از جراحی ثبت شد. <br></span></span></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><span style="font-size: 10pt"><span lang="FA"></span></span><b><span style="font-size: 10pt">یافتهها:</span></b><span style="font-size: 10pt"> 14 بیمار مونث و 37
بیمار مذکر و میانگین سنی بیماران، 48/23 سال بود. </span><span style="font-size: 7pt">FC</span><span style="font-size: 10pt"> بیماران</span><strong><span lang="FA" style="font-size: 10pt"> </span></strong><span style="font-size: 10pt">بعد</span><strong><span lang="FA" style="font-size: 10pt"> </span></strong><span style="font-size: 10pt">از جراحی بهبود قابل
توجهی داشت (001/0</span><span style="font-size: 7pt">P<</span><span style="font-size: 10pt">). میانگین مدت </span><span style="font-size: 7pt">QRS</span><span style="font-size: 10pt"> قبل از
جراحی (89/16</span><span style="font-size: 7pt">SD</span><strong><span style="font-size: 7pt">=</span></strong><span style="font-size: 10pt">) 20/130 و پس از جراحی به (90/16</span><span style="font-size: 7pt">SD</span><strong><span style="font-size: 7pt">=</span></strong><span style="font-size: 10pt">) 45/122 هزارم ثانیه رسیده
(001/0</span><span style="font-size: 7pt">P</span><strong><span style="font-size: 7pt"><</span></strong><span style="font-size: 10pt">) و با </span><span style="font-size: 7pt">FC</span><span style="font-size: 10pt"> پس از عمل
ارتباط معنیداری داشت (028/0</span><span style="font-size: 7pt">P</span><strong><span style="font-size: 7pt">=</span></strong><span style="font-size: 10pt"> و 025/0</span><span style="font-size: 7pt">P</span><strong><span style="font-size: 7pt">=</span></strong><span style="font-size: 10pt">)</span><span style="font-size: 10pt"> در بیمارانی که پس از عمل بدون علامت بودند، </span><span style="font-size: 7pt">QRS</span><span style="font-size: 10pt"> قبل از عمل بهطور معنیداری پایینتر بود<span>. میان اندکسهای سیستولی، دیاستولی با </span></span><span style="font-size: 7pt">FC</span><span style="font-size: 10pt"> پس از عمل
ارتباط معنیداری بهدست آمد (بهترتیب 005/0</span><span style="font-size: 7pt">P</span><strong><span style="font-size: 7pt">=</span></strong><span style="font-size: 10pt"> و 028/0</span><span style="font-size: 7pt">P</span><strong><span style="font-size: 7pt">=</span></strong><span style="font-size: 10pt">) و در بیماران بدون علامت بعد
از جراحی، اندکسهای سیستولی و دیاستولی قبل از جراحی پایینتر بود.</span><em><span style="font-size: 10pt"> <br></span></em></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><em><span style="font-size: 10pt"></span></em><strong><span style="font-size: 10pt">نتیجهگیری:</span></strong><em><span style="font-size: 10pt"> </span></em><span style="font-size: 10pt">میتوان از زمان</span><span style="font-size: 10pt"> </span><span style="font-size: 7pt">QRS</span><span style="font-size: 10pt"> قبل و بعد از عمل و اندکسهای سیستولی و
دیاستولی قبل از عمل، بهعنوان فاکتوری در بررسی وضعیت عملکرد قلبی و تعیین پیشآگهی
بیماران استفاده نمود.</span></p>
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<!--stripped--> <strong>Background:</strong><strong> </strong>The
aim of this study was to evaluate the mid-term outcomes of concurrent total correction of
Tetralogy of Fallot (TOF) after pulmonary valve (PV) replacement and its relation to QRS duration and MRI results.<br><strong>Methods:</strong> <strong> </strong>In
this study, 51 patients with TOF who
had the TOF surgery and PV
replacement enrolled the study. Demographic data, MRI
results such as, right ventricular end diastolic volume, right ventricular end
systolic volume, systolic and diastolic indexes noted. Moreover, QRS
duration and the patients' cardiac functional class were evaluated immediately
before and 6 months after the surgery.<br><strong>Results:</strong> <strong> </strong>From
51
patients, 27.5% were female and 72.5%
were male. The mean age of participants was 23.48 (SD=5.82)
years. Functional class changes were statistically different (P<0.001)
comparing the status before and after the surgery. The mean QRS
duration before surgery was 130.20 (SD=16.89) ms
which was in significant contrast with post-surgical states, 122.45
(SD=16.90) ms (P<0.001). Mean QRS
duration before and after surgery was statistically lower in asymptomatic
patients (P=0.028 and P=0.025,
respectively). There was a statistical relationship between pre-surgical
systolic and diastolic indexes to post-surgical functional class as
asymptomatic patients had lower systolic and diastolic indexes (P=0.005 and
P=0.028,
respectively).<br><strong>Conclusion: </strong> This study demonstrated
that QRS duration before and after
surgery can be an indicator to evaluate the cardiac function after surgery for
Tetralogy of Fallot. Moreover, systolic and diastolic indexes are factors
affecting the good prognosis of patients therefore, PVR surgery needs to be done
before the deterioration of systolic and diastolic indexes and cardiomegaly.</p>
MRI،مدت QRS،تترالوژی فالو،کلاس عملکردی
Functional class,MRI,QRS duration,tetralogy of fallot
588
593
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-199&slc_lang=fa&sid=1
Alizadeh Sani
Z
زهرا
علیزاده ثانی