Li W, Sarubbi B, Sutton R, Somerville J, Gibson D, Henein M Y
Jane Somerville GUCH Unit and Department of Echocardiography, Royal Brompton Hospital and Imperial College, London University, United Kingdom.
J Am Soc Echocardiogr. 2001 Mar;14(3):186-93. doi: 10.1067/mje.2001.110141.
Echocardiography was used to study electromechanical atrial and ventricular function in adult patients with a 1-ventricle heart who were in sinus rhythm to better understand the recurrence of atrial flutter in these conditions. Patients who had recent atrial flutter, with and without the Fontan procedure, were compared with those who had no arrhythmia.
This was a prospective study that used M-mode and 2-dimensional Doppler echocardiography and electrocardiography. Conventional measurements were used to evaluate ventricular long-axis function. Basic data were drawn from case notes. The setting was a designated quaternary service for grown-up congenital heart patients (GUCH) in a tertiary referral center for cardiology and cardiac surgery. From January 1997 to February 1998, 26 consecutive adult patients (aged >16 years) with a heart with one functioning ventricle and a history of atrial flutter were studied: group 1, with non-Fontan palliative surgery or no surgery (10 patients), and group 2, with Fontan-type repair (16 patients). Also studied were 20 patients with a 1-ventricle heart but no history of atrial flutter. These 20 patients were divided into 2 groups: control 1, which comprised 14 patients with previous shunts or no surgery, and control 2, which consisted of 6 patients with Fontan repair.
P-wave duration on the electrocardiogram was similar in the 4 patient groups, but the amplitude was reduced in group 2 and control 2 (patients with Fontan surgery) (P <.016). Bifid P wave was seen in 5 (50%) of 10 patients in group 1 and in 6 (43%) of 14 patients in control 1, but it was not seen in patients with Fontan (P <.01). Ventricular systolic and diastolic dimensions and fractional shortening were not different between patients and controls. Right atrial transverse dimensions were greater in group 2 patients compared with those in controls. Significant atrioventricular valve regurgitation was seen in 9 of 10 group 1 patients but in none of the others. Right-sided total long-axis excursion and atrial A-wave amplitude were depressed in group 2 patients compared with the values in the others. The onset of right atrial shortening was delayed by 50 ms in group 2 compared with control 2, whereas the left atrial shortening was delayed by 30 ms in group 1 compared with control 1. This particular disturbance remained 6 months after cardioversion.
In 1-ventricle hearts, significant atrioventricular valve regurgitation is commonly associated with atrial flutter in patients who did not undergo the Fontan procedure, and with electromechanical disturbances in those who did. Recognition of disturbances in ventricular long-axis function may thus assist in the identification of patients with a 1-ventricle heart who are prone to atrial flutter.
采用超声心动图研究窦性心律的单心室成年患者的心房和心室电机械功能，以更好地了解这些情况下心房扑动的复发情况。将近期有或无Fontan手术的心房扑动患者与无心律失常的患者进行比较。
这是一项前瞻性研究，使用M型和二维多普勒超声心动图以及心电图。采用传统测量方法评估心室长轴功能。基础数据来自病例记录。研究地点是一家三级心脏病学和心脏外科转诊中心为成年先天性心脏病患者（GUCH）设立的指定四级服务机构。1997年1月至1998年2月，连续研究了26例有一个功能心室且有心房扑动病史的成年患者（年龄>16岁）：第1组，接受非Fontan姑息性手术或未手术（10例患者），第2组，接受Fontan型修复（16例患者）。还研究了20例单心室心脏但无心房扑动病史的患者。这20例患者分为2组：对照组1，包括14例曾行分流术或未手术的患者，对照组2，由6例接受Fontan修复的患者组成。
4组患者心电图上的P波持续时间相似，但第2组和对照组2（接受Fontan手术的患者）的P波振幅降低（P<.016）。第1组10例患者中有5例（50%）出现双峰P波，对照组1的14例患者中有6例（43%）出现双峰P波，但Fontan手术患者中未出现（P<.01）。患者和对照组之间的心室收缩和舒张尺寸以及缩短分数没有差异。第2组患者的右心房横径大于对照组。第1组10例患者中有9例出现明显的房室瓣反流，而其他组均未出现。与其他组相比，第2组患者的右侧总长轴偏移和心房A波振幅降低。与对照组2相比，第2组右心房缩短开始延迟50毫秒，而与对照组1相比，第1组左心房缩短延迟30毫秒。这种特殊的紊乱在心律转复后6个月仍存在。
在单心室心脏中，未接受Fontan手术的患者中，明显的房室瓣反流通常与心房扑动有关，而接受Fontan手术的患者则与电机械紊乱有关。因此，认识心室长轴功能紊乱可能有助于识别易患心房扑动的单心室心脏患者。
