McBride Michael G, Kirshbom Paul M, Gaynor J William, Ittenbach Richard F, Wernovsky Gil, Clancy Robert R, Flynn Thomas B, Hartman Diane M, Spray Thomas L, Tanel Ronn E, Santiago Mayra C, Paridon Stephen M
Division of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa 19104, USA.
J Thorac Cardiovasc Surg. 2007 Jun;133(6):1533-9. doi: 10.1016/j.jtcvs.2006.12.032.
We evaluated cardiopulmonary function at rest and during exercise in children after surgical repair for total anomalous pulmonary venous connection.
Long-term assessment of cardiopulmonary function during exercise in children after repair for total anomalous pulmonary venous connection during infancy is limited.
Resting lung function and cardiopulmonary function during maximal ramp cycle ergometry were evaluated in 27 patients (age = 11 +/- 4 years, 20 were male). Peak oxygen consumption, ventilatory anaerobic threshold, and physical working capacity were compared with normal reference values. Neurologic assessment included neuromuscular function, inattentiveness, and hyperactivity. Patient- and procedure-related variables were assessed for association with peak oxygen consumption, ventilatory anaerobic threshold, and physical working capacity.
Compared with healthy children, peak oxygen consumption (88% +/- 16% of predicted) and ventilatory anaerobic threshold (91% +/- 21% of predicted) were mildly reduced. Chronotropic impairment was observed in 7 patients (32%). Patients with impaired resting lung mechanics were more likely to have impairment in peak oxygen consumption (P < .05). Breathing reserve was normal. Specific anatomy and all operative factors did not have a significant impact on overall exercise performance. Composite score for fine and gross motor function was associated with lower ventilatory anaerobic threshold (P < .05).
Exercise performance is mildly impaired at long-term follow-up after total anomalous pulmonary venous connection repair during infancy. Residual pulmonary abnormalities are common and associated with lower exercise performance. Neurologic abnormalities are evident in a subgroup, but the impact on late exercise performance is inconclusive.
我们评估了完全性肺静脉异位连接手术修复后儿童静息和运动时的心肺功能。
婴儿期完全性肺静脉异位连接修复后儿童运动时心肺功能的长期评估有限。
对27例患者（年龄 = 11±4岁，20例为男性）进行了静息肺功能和最大斜坡周期运动试验时的心肺功能评估。将峰值耗氧量、通气无氧阈和体力工作能力与正常参考值进行比较。神经学评估包括神经肌肉功能、注意力不集中和多动。评估患者及手术相关变量与峰值耗氧量、通气无氧阈和体力工作能力的相关性。
与健康儿童相比，峰值耗氧量（预测值的88%±16%）和通气无氧阈（预测值的91%±21%）轻度降低。7例患者（32%）观察到变时性功能障碍。静息肺力学受损的患者更有可能出现峰值耗氧量受损（P < 0.05）。呼吸储备正常。特定解剖结构和所有手术因素对总体运动表现没有显著影响。精细和粗大运动功能综合评分与较低的通气无氧阈相关（P < 0.05）。
婴儿期完全性肺静脉异位连接修复后的长期随访中运动表现轻度受损。残留肺部异常常见且与较低的运动表现相关。神经学异常在一个亚组中明显，但对后期运动表现的影响尚无定论。
