Mahle W T, McBride M G, Paridon S M
Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
Am J Cardiol. 2001 Mar 15;87(6):753-8. doi: 10.1016/s0002-9149(00)01496-x.
Early- and intermediate-term results of the arterial switch operation for D-transposition of the great arteries (D-TGA) are encouraging. However, questions remain about the long-term outcome for these patients, especially with regard to exercise performance. Preliminary studies have demonstrated normal endurance time on treadmills. However, data regarding aerobic capacity and cardiopulmonary function are lacking. We report the cardiopulmonary performance of 22 school-age patients with D-TGA who underwent the arterial switch operation. Outcome variables included maximal oxygen consumption (VO2), maximal cardiac index, and peak heart rate. Patient and procedure-related variables were assessed for their association with outcome variables using linear and logistic regression. The mean values of maximal VO2 (113 +/- 19% predicted) and maximal cardiac index (96 +/- 18% predicted) were within normal limits for the pediatric population. Although the mean peak heart rate for the entire group (184 +/- 14 beats/min) was within normal limits, there were 7 subjects (32%) with chronotropic impairment. Significant ST-segment depression was seen in 2 subjects (9%). In regression analysis, surgery subsequent to the arterial switch was associated with lower maximal cardiac index (p = 0.01). Other variables were not significantly associated with maximal VO2, maximal cardiac index, and peak heart rate. In particular, chronotropic impairment was not significantly associated with maximal VO2 or maximal cardiac index. These findings demonstrate that cardiopulmonary performance during exercise is excellent after the arterial switch operation. The finding of ST-segment depression in some subjects supports the role of formal exercise testing in those patients participating in vigorous athletic activities.
大动脉转位（D-TGA）动脉调转术的早期和中期结果令人鼓舞。然而，这些患者的长期预后仍存在疑问，尤其是在运动能力方面。初步研究显示在跑步机上的耐力时间正常。然而，关于有氧能力和心肺功能的数据尚缺乏。我们报告了22例接受动脉调转术的学龄期D-TGA患者的心肺功能表现。结果变量包括最大摄氧量（VO2）、最大心指数和心率峰值。使用线性和逻辑回归评估患者及与手术相关的变量与结果变量之间的关联。最大VO2（预测值的113±19%）和最大心指数（预测值的96±18%）的平均值在儿科人群的正常范围内。尽管整个组的平均心率峰值（184±14次/分钟）在正常范围内，但有7名受试者（32%）存在变时性功能不全。2名受试者（9%）出现显著的ST段压低。在回归分析中，动脉调转术后的再次手术与较低的最大心指数相关（p = 0.01）。其他变量与最大VO2、最大心指数和心率峰值无显著关联。特别是，变时性功能不全与最大VO2或最大心指数无显著关联。这些发现表明，动脉调转术后运动期间的心肺功能表现良好。部分受试者出现ST段压低的结果支持了对参与剧烈体育活动的患者进行正式运动测试的作用。
