Sanghavi Darshak M, Flanagan Michael, Powell Andrew J, Curran Tracy, Picard Sarah, Rhodes Jonathan
Division of Pediatric Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Am J Cardiol. 2006 Jun 1;97(11):1638-43. doi: 10.1016/j.amjcard.2005.12.057. Epub 2006 Apr 19.
This study aimed to determine whether the exercise capacity of patients with pulmonary atresia/intact ventricular septum (PA/IVS) who have undergone biventricular repair is superior to that of patients with single ventricle repairs and to account for any differences. PA/IVS is generally treated with either biventricular (outflow tract reconstruction) or univentricular (Fontan) palliation. Although biventricular repair is believed to result in superior exercise function, this theory is untested. Symptom-limited programmed bicycle ergonometry with expiratory gas analysis was prospectively performed on all patients with PA/IVS >7 years old seen over 18 months. Nineteen biventricular and 10 Fontan patients (mean age 16.5 +/- 6.5 vs 12.7 +/- 5.0 years, p = 0.12) were enrolled. The exercise capacity of biventricular patients was not statistically superior to that of Fontan patients (predicted peak VO2 83.5 +/- 21% vs 76.0 +/- 17.5%, p = 0.34), although chronotropic function and ventilatory efficiency were significantly better in the former. The peak exercise capacity varied widely within each group, and there was considerable overlap between biventricular and Fontan patients. Within groups, imaging studies did not reliably predict exercise capacity. Most patients in each group had subnormal peak VO2, and there was a trend toward impaired performance with increasing age regardless of type of repair. In conclusion, biventricular repair may not guarantee superior exercise performance over single-ventricle palliation in PA/IVS. Regardless of repair type, aerobic capacity may deteriorate with age and is not reliably predicted by noninvasive imaging. These findings underscore the need for a quantitative, proactive approach to the assessment and preservation of exercise function.
本研究旨在确定接受双心室修复的肺动脉闭锁/室间隔完整（PA/IVS）患者的运动能力是否优于接受单心室修复的患者，并解释其中的差异。PA/IVS一般采用双心室（流出道重建）或单心室（Fontan）姑息治疗。尽管人们认为双心室修复可带来更好的运动功能，但这一理论尚未得到验证。对18个月内就诊的所有年龄大于7岁的PA/IVS患者前瞻性地进行了症状限制性程控自行车测力计测试及呼气气体分析。纳入了19例接受双心室修复和10例接受Fontan手术的患者（平均年龄分别为16.5±6.5岁和12.7±5.0岁，p = 0.12）。双心室修复患者的运动能力在统计学上并不优于Fontan手术患者（预测峰值VO2分别为83.5±21%和76.0±17.5%，p = 0.34），尽管前者的变时性功能和通气效率明显更好。每组内的峰值运动能力差异很大，双心室修复和Fontan手术患者之间有相当大的重叠。在组内，影像学检查不能可靠地预测运动能力。每组中的大多数患者峰值VO2低于正常，且无论修复类型如何，随着年龄增长均有运动能力受损的趋势。总之，在PA/IVS患者中，双心室修复可能无法保证比单心室姑息治疗有更好的运动表现。无论修复类型如何，有氧运动能力可能会随着年龄增长而下降，且无创影像学检查不能可靠地预测。这些发现强调了需要一种定量、积极主动的方法来评估和维持运动功能。
