先天性心脏病患者运动时右心室与左心室作为体循环心室的比较。

Comparison of the right and left ventricle as a systemic ventricle during exercise in patients with congenital heart disease.

作者信息

Ohuchi H, Hiraumi Y, Tasato H, Kuwahara A, Chado H, Toyohara K, Arakaki Y, Yagihara T, Kamiya T

机构信息

Department of Pediatrics and Thoracic Surgery, National Cardiovascular Center, Fujishiro-dai, Suita, Osaka 565, Japan.

出版信息

Am Heart J. 1999 Jun;137(6):1185-94. doi: 10.1016/s0002-8703(99)70381-9.

DOI:10.1016/s0002-8703(99)70381-9

PMID:10347350

Abstract

BACKGROUND

Few studies have investigated the clinical advantages of surgical correction with the morphologic left ventricle (MLV) instead of the morphologic right ventricle as a systemic ventricle (SV) in patients with congenital heart disease.

METHODS

Twenty-four healthy control subjects (group A1), 6 patients with isolated congenitally corrected transposition of the great arteries (TGA) (group A2), 16 patients with TGA who had undergone an arterial switch operation (group B1), 18 patients with TGA who had undergone a venous switch operation (group B2), 9 patients with atrioventricular and ventriculoarterial discordance who had undergone a double switch operation (group C1), and 6 patients with atrioventricular and ventriculoarterial discordance who had undergone a conventional external conduit operation from the MLV to the pulmonary artery (group C2), performed treadmill exercise testing. Their heart rate (HR), oxygen uptake (VO2), and oxygen pulse (O2 pulse), which reflects individual stroke volume, were measured, and contractile function was assessed by echocardiography.

RESULTS

The peak HR for the patients after a definitive operation were significantly lower than that in group A1 and was correlated with peak VO2 (r =.67, P <.0001). The peak VO2 and peak O2 pulse for the groups A2 and B2 were significantly lower than those for the groups A1 and B1, respectively. The peak O2 pulse data were strongly correlated with those of peak VO 2 (r = 0.91, P <.0001). The left ventricular ejection fraction was significantly lower in groups B1 and C1 than in group A1 and was correlated with peak VO 2 (r =.50, P <.01). No significant differences in VO2, HR, and O 2 pulse at peak exercise were observed between groups C1 and C2.

CONCLUSIONS

Chronotropic incompetence and an impaired response of the stroke volume of the MRV during exercise are partly responsible for the reduced exercise capacity in groups A2 and B2 compared with groups with the MLV as an SV, and the SV function at rest is also related to exercise capacity. Superiority of the double-switch operation compared with the conventional conduit operation was not observed. A longer-term follow-up is necessary before the advantages of these 2 operations can be compared.

摘要

背景

很少有研究探讨在先天性心脏病患者中，以形态学左心室（MLV）而非形态学右心室作为体循环心室（SV）进行手术矫正的临床优势。

方法

24名健康对照者（A1组），6例单纯先天性矫正型大动脉转位（TGA）患者（A2组），16例接受动脉调转术的TGA患者（B1组），18例接受静脉调转术的TGA患者（B2组），9例房室和心室动脉不一致且接受双调转术的患者（C1组），以及6例房室和心室动脉不一致且接受从MLV到肺动脉的传统外管道手术的患者（C2组），进行了平板运动试验。测量他们的心率（HR）、摄氧量（VO2）和反映个体每搏量的氧脉搏（O2脉搏），并通过超声心动图评估收缩功能。

结果

确定性手术后患者的峰值HR显著低于A1组，且与峰值VO2相关（r = 0.67，P < 0.0001）。A2组和B2组的峰值VO2和峰值O2脉搏分别显著低于A1组和B1组。峰值O2脉搏数据与峰值VO2数据高度相关（r = 0.91，P < 0.0001）。B1组和C1组的左心室射血分数显著低于A1组，且与峰值VO2相关（r = 0.50，P < 0.01）。C1组和C2组在运动峰值时的VO2、HR和O2脉搏无显著差异。