Rowe S A, Zahka K G, Manolio T A, Horneffer P J, Kidd L
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205.
J Am Coll Cardiol. 1991 Feb;17(2):461-6. doi: 10.1016/s0735-1097(10)80116-0.
Fifty-five patients with repair of tetralogy of Fallot were evaluated with treadmill exercise, pulmonary function testing and rest two-dimensional and Doppler echocardiography to determine the relation among cardiopulmonary function, exercise capacity and ventricular arrhythmias. The mean age at repair was 8.1 +/- 2.1 years; age at the time of study ranged from 15 to 37 years (mean follow-up time after repair 18 +/- 5 years). Exercise duration was 92 +/- 17% of predicted. Maximal heart rate was 94 +/- 7% of predicted. No exercise test was stopped because of an arrhythmia. Thirty patients had oxygen consumption and ventilation measured during their final minute of exercise. Peak oxygen consumption was 31 +/- 8 ml/kg per min (86 +/- 18% of predicted). Twenty-five patients (45%) had low vital capacity at rest (less than 80% of predicted). Pulmonary regurgitation was identified in 42 (75%) of the patients and judged to be moderate in 10 (18%). Mild tricuspid valve regurgitation was identified in 64%. Doppler estimated right ventricular outflow gradient was greater than 15 mm Hg in 15% of the patients (mean gradient 24 mm Hg [range 16 to 56]). Age at repair, duration of follow-up and type of repair did not correlate with echocardiographic variables, ventilatory data, exercise performance or arrhythmias. Moderate pulmonary regurgitation was associated with increased right ventricular diastolic area and both were inversely related to exercise duration and vital capacity. Decreased breathing reserve during maximal exercise was associated with moderate pulmonary regurgitation and decreased vital capacity. The results indicate that exercise capacity in these patients is in general good; however, right ventricular volume loading and ventilatory dysfunction may produce exercise limitation.
对55例法洛四联症修复术后患者进行了平板运动试验、肺功能测试以及静息二维和多普勒超声心动图检查，以确定心肺功能、运动能力和室性心律失常之间的关系。修复手术时的平均年龄为8.1±2.1岁；研究时的年龄范围为15至37岁（修复术后平均随访时间为18±5年）。运动持续时间为预测值的92±17%。最大心率为预测值的94±7%。没有因心律失常而停止运动试验。30例患者在运动的最后一分钟测量了耗氧量和通气量。峰值耗氧量为31±8 ml/kg每分钟（为预测值的86±18%）。25例患者（45%）静息时肺活量较低（低于预测值的80%）。42例（75%）患者发现有肺动脉反流，其中10例（18%）被判定为中度。64%的患者发现有轻度三尖瓣反流。15%的患者多普勒估计右心室流出道梯度大于15 mmHg（平均梯度24 mmHg [范围16至56]）。修复时的年龄、随访时间和修复类型与超声心动图变量、通气数据、运动表现或心律失常均无相关性。中度肺动脉反流与右心室舒张面积增加相关，且两者均与运动持续时间和肺活量呈负相关。最大运动时呼吸储备减少与中度肺动脉反流和肺活量降低相关。结果表明，这些患者的运动能力总体良好；然而，右心室容量负荷和通气功能障碍可能导致运动受限。
