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目的 研究法洛四联症 (TOF)右心室流出道心肌细胞的超微结构变化及心肌组织的生物力学性能。方法 对 2 4例TOF根治术手术前后的右心室及肺动脉的压力变化进行对比研究。对其中 7例TOF与对照组 7例先心病小室缺、小房缺应用透射电镜进行右心室流出道心肌的超微结构研究。对 4例TOF与 2例非先心病死亡右心室心肌进行多样本量的对比 ,采用计算机控制的小力学量软组织力学测试平台进行右心室心肌力学的研究。结果 TOF右心室流出道的心肌组织存在着很多超微结构异常的心肌细胞。TOF右心室流出道心肌组织的力学特点表现为过软 ,而右心室外壁表现为过硬 ,TOF根治术经过较为彻底地切除肥厚肌束 ,没有残余右心室流出道梗阻存在 ,肺动脉瓣前后无阶差存在 ,P >0 .0 5。 2 4例TOF无手术死亡。结论 建议TOF根治中 ,在疏通右心室流出道、切除肥厚肌束时不必过分考虑其功能作用。
Objective To investigate the ultrastructural changes of cardiomyocytes in right ventricular outflow tract of tetralogy of Fallot (TOF) and the biomechanical properties of myocardial tissue. Methods The changes of pressure in right ventricle and pulmonary artery before and after 24 cases TOF were compared. Seven cases of TOF and control group, 7 cases of congenital heart disease, lack of small chamber, small chamber electron microscopy of the right ventricular outflow tract myocardial ultrastructure. Four cases of TOF and 2 cases of non-congenital heart disease right ventricular myocardium were compared for different sample sizes, using computer-controlled small amount of soft tissue mechanics test platform right ventricular myocardial mechanics. Results TOF right ventricular outflow tract myocardial tissue there are many ultrastructural abnormalities of myocardial cells. TOF right ventricular outflow tract myocardial mechanical performance was too soft, while the right ventricle wall showed excellent, TOF radical mastectomy after a more complete removal of hypertrophic muscle bundles, there is no residual right ventricular outflow tract obstruction exists before and after pulmonary valve non-level difference Exists, P> 0 .0 5. Twenty-four TOFs died without surgery. Conclusions It is suggested that in TOF radicalization, it is not necessary to consider its function in removing right ventricular outflow tract and excising hypertrophic muscle bundle.