Akagi T, Benson L N, Green M, De Souza M, Harder J R, Gilday D L, Freedom R M
Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.
Am J Cardiol. 1991 Jun 1;67(15):1273-8. doi: 10.1016/0002-9149(91)90940-m.
Fourteen patients with univentricular connection, absent right connection (tricuspid valve atresia) and normally related great arteries underwent rest and supine bicycle exercise equilibrium radionuclide blood pool studies. Ejection fraction, heart rate, systemic blood pressure and oxygen saturation (ear oximetry) were measured. There were 6 male and 8 female patients. Mean age +/- standard error of the mean was 14.5 +/- 1.1 years (range 6.3 to 21.1). Eight patients (group 1) had systemic to pulmonary shunts placed as palliation 8.2 +/- 2.2 years before study and 6 patients (group II) had caval to pulmonary shunts placed 11.8 +/- 1.6 years previously. Ejection fraction at rest was 54 +/- 2% and an abnormal response to exercise (failure of ejection fraction to increase greater than or equal to 5% from rest to peak exercise) was found in 9 of 14 patients. When analyzed separately, ejection fraction at rest in group I was higher than in group II; however, this difference disappeared at peak exercise. There was a significant negative correlation between ejection fraction at peak exercise and the interval since palliative surgery, although it was not apparent at rest. These data suggest that ventricular function is compromised during exercise and that abnormal performance is influenced by long-standing volume overload. Importantly, this abnormal state is concealed at rest and the choice of palliative shunting procedure appears to have little effect on normalizing pump performance.
14例单心室连接、右心连接缺如（三尖瓣闭锁）且大动脉关系正常的患者接受了静息和仰卧位踏车运动平衡放射性核素血池研究。测量了射血分数、心率、体循环血压和血氧饱和度（耳部血氧测定）。有6例男性和8例女性患者。平均年龄±平均标准误差为14.5±1.1岁（范围6.3至21.1岁）。8例患者（第1组）在研究前8.2±2.2年进行了体肺分流作为姑息治疗，6例患者（第II组）在11.8±1.6年前进行了腔肺分流。静息时射血分数为54±2%，14例患者中有9例运动反应异常（射血分数从静息到运动峰值未增加≥5%）。单独分析时，第I组静息时的射血分数高于第II组；然而，这种差异在运动峰值时消失。运动峰值时的射血分数与姑息手术后的时间间隔之间存在显著负相关，尽管在静息时不明显。这些数据表明运动期间心室功能受损，异常表现受长期容量超负荷影响。重要的是，这种异常状态在静息时被掩盖，姑息性分流手术的选择似乎对使泵功能正常化影响不大。
