Cecconi M, Colonna P, Bettuzzi M G, Manfrin M, Cesari G P, Berrettini U, Budini A, Brianzoni E, Latini R, Soro A
Ospedale Cardiologico G.M. Lancisi, Ancona.
G Ital Cardiol. 1991 Feb;21(2):175-88.
Patients who have undergone surgical repair of congenital heart diseases are usually not allowed to participate in competitive sports. In the present study we report our long-term experience with 9 male athletes aged 17 to 23 years who participate in competitive sports after undergoing surgical repair of ostium secundum atrial septal defect at a median age of 9 years; six of them play football and three of them volleyball. Competitive sport activities began 1 to 5 years after surgical repair. The mean duration of follow-up is 88 +/- 26 months. Sport fitness was granted on the basis of the following criteria: 1) a normal physical examination; 2) a normal working capacity on exercise test; 3) no arrhythmias on exercise test and Holter monitoring, recorded also during sport activities; 4) a normal M-mode and two-dimensional echocardiography, including the normalization of right ventricular size; the persistence of an abnormal ventricular septal motion did not exclude sport fitness. Recently we also performed Doppler and color Doppler echocardiography and gated equilibrium radionuclide angiography at rest and during exercise. We studied left ventricular diastolic filling through the pulsed wave Doppler evaluation of transmitral flow and measured cardiac output by continuous wave Doppler echocardiography during exercise test in the supine position. We also performed exercise test and M-mode, two-dimensional, Doppler and color Doppler echocardiography in a control group made up of 15 athletes (10 football players and 5 volleyball players). The exercise duration at graded treadmill exercise test (according to the Carù protocol), the maximal heart rate and the maximal systolic blood pressure were, respectively, 12.9 +/- 0.8 min, 192 +/- 10 beats/min and 198 +/- 12 mmHg. Left ventricular end-diastolic dimension, mass and ejection fraction (single-plane area-length method) were 50.3 +/- 2.8 mm, 210 +/- 38 g and 65 +/- 6%. M-mode right ventricular diastolic dimension was 23.4 +/- 1.6 mm; the right ventricular maximal diastolic diameter and area obtained on two-dimensional echocardiography from the apical four chamber view were 44.1 +/- 3.6 mm and 25 +/- 3.8 cm2 respectively. The evaluation of transmitral flow showed the following data: E velocity 77 +/- 12 cm/sec, A velocity 45 +/- 6 cm/sec, E/A ratio 1.7 +/- 0.3, the isovolumic-relaxation period 72 +/- 8 m/sec and the deceleration half-time of the early rapid filling 71 +/- 10 m/sec. A trivial tricuspid regurgitation was detected in 6 subjects; the peak velocity of the regurgitant jet was less than 2.1 m/sec.(ABSTRACT TRUNCATED AT 400 WORDS)
接受过先天性心脏病手术修复的患者通常不被允许参加竞技性运动。在本研究中，我们报告了9名年龄在17至23岁之间的男性运动员的长期情况，他们在平均9岁时接受了继发孔型房间隔缺损的手术修复，之后参加竞技性运动；其中6人踢足球，3人打排球。竞技性体育活动在手术修复后1至5年开始。平均随访时间为88±26个月。根据以下标准给予运动许可：1）体格检查正常；2）运动试验时工作能力正常；3）运动试验和动态心电图监测时无心律失常，运动活动期间也进行记录；4）M型和二维超声心动图正常，包括右心室大小正常化；室间隔运动异常持续存在并不排除运动许可。最近，我们还在静息和运动时进行了多普勒和彩色多普勒超声心动图以及门控平衡放射性核素血管造影。我们通过二尖瓣血流的脉冲波多普勒评估研究左心室舒张期充盈，并在仰卧位运动试验期间通过连续波多普勒超声心动图测量心输出量。我们还在由15名运动员（10名足球运动员和5名排球运动员）组成的对照组中进行了运动试验以及M型、二维、多普勒和彩色多普勒超声心动图检查。分级平板运动试验（根据卡鲁方案）的运动持续时间、最大心率和最大收缩压分别为12.9±0.8分钟、192±10次/分钟和198±12毫米汞柱。左心室舒张末期内径、质量和射血分数（单平面面积-长度法）分别为50.3±2.8毫米、210±38克和65±6%。M型右心室舒张期内径为23.4±1.6毫米；从心尖四腔视图二维超声心动图获得的右心室最大舒张直径和面积分别为44.1±3.6毫米和25±3.8平方厘米。二尖瓣血流评估显示以下数据：E速度77±12厘米/秒，A速度45±6厘米/秒，E/A比值1.7±0.3，等容舒张期72±8毫秒，早期快速充盈减速半衰期71±10毫秒。6名受试者检测到轻微三尖瓣反流；反流束峰值速度小于2.1米/秒。（摘要截断于400字）
