Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2010 Jan;37(1):204-9. doi: 10.1016/j.ejcts.2009.06.053. Epub 2009 Aug 14.
Early circuit separation enhances the long-term success of Fontan haemodynamics. To test this hypothesis, we analysed the postoperative cardiopulmonary capacity in children and adults.
Spiroergometry was performed at least twice in 43 patients with a median age of 14 (range: 7-43) years, with a median time interval of 4.6 (1.1-10.4) years between early and late testing. Twenty-eight patients had been operated on in childhood and 15 as adults. The exercise capacity (W(max)) and oxygen consumption capacity (VO(2max)) were compared between children and adults.
The VO(2max) in children early postoperatively was better than in adults (median 27.9 vs 22.9, p=0.032). Both VO(2max) (median 30.1 ml min(-1) kg(-1) vs 16.9 ml min(-1)kg(-1), p<0.001), and W(max) (median 2.2 W kg(-1) vs 1.4 W kg(-1), p<0.001) were significantly better in children late after surgery. In the patient group as a whole, there was a significant decrease of VO(2max) between early and later testing (median 26.5 l min(-1) kg(-1) vs 20.7 l min(-1) kg(-1), p<0.001).
Fontan palliation in early childhood results in better cardiopulmonary capacity during long-term follow-up. Regular surveillance of the physical capacity by spiroergometry is indispensable for the supervision of patients with Fontan haemodynamics.
早期回路分离可提高 Fontan 血流动力学的长期成功率。为了验证这一假说，我们分析了儿童和成人患者的术后心肺能力。
对 43 例患者进行了至少两次的心肺运动测试，中位年龄为 14 岁（范围：7-43 岁），早期和晚期测试之间的中位时间间隔为 4.6 年（1.1-10.4 年）。28 例患者在儿童时期接受手术，15 例患者在成年后接受手术。比较了儿童和成人的运动能力（W(max)）和耗氧量能力（VO(2max)）。
儿童术后早期的 VO(2max)优于成人（中位数 27.9 比 22.9，p=0.032）。术后晚期，VO(2max)（中位数 30.1 ml min(-1)kg(-1)比 16.9 ml min(-1)kg(-1)，p<0.001）和 W(max)（中位数 2.2 W kg(-1)比 1.4 W kg(-1)，p<0.001）均显著改善。在整个患者组中，VO(2max)在早期和晚期测试之间有显著下降（中位数 26.5 l min(-1)kg(-1)比 20.7 l min(-1)kg(-1)，p<0.001）。
Fontan 姑息术在儿童早期进行可导致长期随访期间心肺能力更好。通过心肺运动测试定期监测体力对于 Fontan 血流动力学患者的监护是不可或缺的。
