Veeram Reddy Surendranath Reddy, Du Wei, Zilberman Mark V
Children's Hospital of Michigan, Division of Cardiology, The Carmen and Ann Adams Department of Pediatrics, Detroit, MI 48201, USA.
Congenit Heart Dis. 2009 Nov-Dec;4(6):454-8. doi: 10.1111/j.1747-0803.2009.00332.x.
Patients with large ventricular septal defects (VSDs) undergo surgical patch closure during infancy. The long-term effects of the presence of akinetic patch in the ventricular septum and postoperative right bundle branch block (RBBB) on the left ventricular (LV) mechanical synchrony and global systolic function have not been studied.
The objective of this study was to evaluate the long-term effects of an akinetic VSD patch and RBBB on the LV mechanical synchrony and global systolic function in pediatric patients more than 5 years after surgery.
Eighteen asymptomatic VSD repair and 18 normal control patients were evaluated by an electrocardiogram and three-dimensional echocardiography. Left ventricular end-diastolic volumes (LVEDVs) and volumetric ejection fraction (EF) were calculated. Left ventricular intraventricular synchrony was assessed by the 16-segment volumetric dyssynchrony index.
Eight of 18 (44%) patients in the VSD repair group had RBBB. The LVEDV and volumetric EF were similar in the VSD repair and control groups. The LV dyssynchrony index was not significantly different between the VSD repair and control groups (2.46 +/- 1.77% vs. 1.75 +/- 1.08%, P = .16). The VSD repair group was then divided into two subgroups: patients with RBBB (8/18) and those without RBBB (10/18). The two subgroups were similar in demographics, LVEDV, and volumetric EF. However, the RBBB subgroup demonstrated significant LV mechanical dyssynchrony compared with the non-RBBB VSD subgroup (2.70 +/- 1.08% vs. 1.15 +/- 0.35%, P = .006).
Pediatric patients 5-10 years after VSD patch closure have a normal LV function. The presence of the RBBB causes some mechanical dyssynchrony and tendency toward LV dilatation in this group of patients. Therefore, long-term follow-up of these patients is warranted.
大型室间隔缺损（VSD）患者在婴儿期接受手术修补。室间隔运动减弱的补片及术后右束支传导阻滞（RBBB）对左心室（LV）机械同步性和整体收缩功能的长期影响尚未得到研究。
本研究的目的是评估手术5年以上的儿科患者中，运动减弱的VSD补片和RBBB对LV机械同步性和整体收缩功能的长期影响。
通过心电图和三维超声心动图对18例无症状VSD修补患者和18例正常对照患者进行评估。计算左心室舒张末期容积（LVEDV）和容积射血分数（EF）。通过16节段容积不同步指数评估左心室内同步性。
VSD修补组18例患者中有8例（44%）发生RBBB。VSD修补组和对照组的LVEDV和容积EF相似。VSD修补组和对照组的LV不同步指数无显著差异（2.46±1.77%对1.75±1.08%，P = 0.16）。然后将VSD修补组分为两个亚组：发生RBBB的患者（8/18）和未发生RBBB的患者（10/18）。两个亚组在人口统计学、LVEDV和容积EF方面相似。然而，与非RBBB的VSD亚组相比，RBBB亚组表现出显著的LV机械不同步（2.70±1.08%对1.15±0.35%，P = 0.006）。
VSD补片闭合术后5至10年的儿科患者左心室功能正常。RBBB的存在导致该组患者出现一些机械不同步和左心室扩张倾向。因此，有必要对这些患者进行长期随访。
