Mocellin R, Thrul P, Bühlmeyer K
Z Kardiol. 1976 Nov;65(11):1033-43.
The development of pulmonary vascular resistance was studied in 33 children with large ventricular septal defects, whose first heart catheterization had been accomplished during the first year of life and who had been recatheterized at least once before surgery had been performed. In 6 children infundibular stenosis developed, which was already seen during the first investigation in 5 cases. The other 27 patients were divided into 4 groups according to the left to right shunt ( less than 60%' greater than 59%) and to the pulmonary arterial pressure (PPsyst: PSsyst less than 80 : 100; PPsyst: PSsyst greater than 79 : 100). The results show that secondary elevatin of pulmonary vascular resistance after an initial fall is a frequent phenomenon, but that in some cases pulmonary vascular resistance is never low. In some other cases pulmonary vascular resistance does not rise again after the initial fall inspite of a high left to right shunt, sporadically because the defect has become smaller. The results are not in full agreement with the concept of Hoffman and Rudolph, who generally postulate an initial fall of pulmonary vascular resistance and who concede a later elevation of pulmonary vascular resistance only as consequence of a secondary re-increase. The concept of Bloomfield, on the other hand, seems suitable to interprete the different patterns.
对33例大型室间隔缺损患儿的肺血管阻力发展情况进行了研究，这些患儿在出生后第一年内首次进行了心导管检查，且在手术前至少再次进行过一次导管检查。6例患儿出现漏斗部狭窄，其中5例在首次检查时就已发现。根据左向右分流（小于60%、大于59%）和肺动脉压（收缩期肺动脉压：收缩期体动脉压小于80:100；收缩期肺动脉压：收缩期体动脉压大于79:100），将另外27例患者分为4组。结果表明，肺血管阻力在最初下降后继发升高是一种常见现象，但在某些情况下肺血管阻力从未降低。在其他一些情况下，尽管左向右分流量很大，但肺血管阻力在最初下降后并未再次升高，偶尔是因为缺损变小。结果与霍夫曼和鲁道夫的概念不完全一致，他们通常假定肺血管阻力最初会下降，并且仅承认后期肺血管阻力升高是继发再增加的结果。另一方面，布卢姆菲尔德的概念似乎适合解释不同的模式。
