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28 法洛氏四合症(Tetralogy of Fallot)完全矯正後,長期追蹤若有嚴重的肺動脈瓣逆流,右心室擴大,及右心室功能失效,此時最好的處理方式為何?
(A)心房中隔造口(creation of atrial septal defect)
(B)肺動脈瓣置換
(C)三尖瓣置換
(D)使用降肺高壓藥物


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10
 【站僕】摩檸Morning:有沒有達人來解釋一下?
倒數 1天 ,已有 1 則答案
Chris 大二下 (2020/05/05):

Uptodate

Chronic pulmonary regurgitation — Intracardiac repair with a transannular RVOT patch results in obligate chronic severe pulmonary regurgitation. Insufficiency may also occur in patients who have monocusp valves placed at the time of initial repair or who have a valved conduit from the RV to the pulmonary artery (PA), as these valves become progressively incompetent over time. The degree of insufficiency may vary depending on surgical approach and on the presence or absence of associated PA stenosis. In the setting of long-standing severe pulmonary regurgitation, the RV enlarges due to increased workload [33,34]. This may be associated with increasing tricuspid insufficiency, further contributing to RV enlargement.

Right ventricular enlargement and function — Patients with RV enlargement and with normal RV function are asymptomatic. However, they are at risk for the evolution of RV dysfunction, associated with decreased exercise tolerance, right heart failure, and arrhythmias (ie, VT, atrial flutter, and atrial fibrillation). The decline in RV function can also lead to left ventricular (LV) dysfunction due to septal shift and ventricular/ventricular interaction [33,35,36].

Pulmonary valve replacement and right ventricular function — Pulmonary valve replacement (PVR) may be necessary to restore pulmonary valve competence and improve RV function [37-41]. Although optimal timing of PVR remains uncertain, this option should be considered in symptomatic patients as well as in those with moderate or severe RV volume overload, RV dysfunction, tricuspid valve regurgitation, and clinical arrhythmias attributable to the right heart enlargement/dysfunction from pulmonary valve regurgitation. Ideally, PVR should occur before severe RV dysfunction develops.

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28 法洛氏四合症(Tetralogy of Fallot)完全矯正後,長期追蹤..-阿摩線上測驗