Beppu S, Naito H, Matsuhisa M, Miyatake K, Nimura Y
National Cardiovascular Center, Research Institute and Hospital, Osaka, Japan.
Am Heart J. 1990 Nov;120(5):1159-66. doi: 10.1016/0002-8703(90)90131-g.
In patients with congenital absence of the left pericardium, the heart is supported by the existing right pericardium in the right lateral position, while it is not in the left lateral position. To investigate the change in ventricular size resulting from postural change, seven patients with this malformation were examined. Ventricular volumes were calculated by computed tomography, integrating areas of computed tomographic cross sections measured at 1 cm intervals from the cardiac apex to the aortic arch. In the right lateral position, right ventricular (RV) and left ventricular (LV) volumes were no different from those of five control subjects. With a change in the lying position to the left, the increase in the ventricular volume was significantly greater than that in the control subjects (35 +/- 11 versus 3 +/- 3 ml in the right ventricle and 15 +/- 13 versus 3 +/- 8 ml in the left ventricle). The increases in RV and LV end-diastolic pressure, however, were almost the same as those in the 11 control subjects. It is concluded that the cardiac ventricle, especially the right ventricle, dilates significantly with a small increase in preload in patients with congenital absence of the pericardium. It may be a clue for clarifying the ventricular distensibility being freed from physiologic restraint of the pericardium for a long period.
在先天性左心包缺如的患者中，心脏在右侧卧位时由现存的右心包支撑，而在左侧卧位时则不然。为了研究体位改变导致的心室大小变化，对7例患有这种畸形的患者进行了检查。通过计算机断层扫描计算心室容积，将从心尖到主动脉弓以1厘米间隔测量的计算机断层扫描横截面面积进行积分。在右侧卧位时，右心室（RV）和左心室（LV）容积与5名对照受试者的容积无差异。随着卧位变为左侧，心室容积的增加显著大于对照受试者（右心室为35±11对3±3毫升，左心室为15±13对3±8毫升）。然而，右心室和左心室舒张末期压力的增加与11名对照受试者的增加几乎相同。得出的结论是，在先天性心包缺如的患者中，心脏心室，尤其是右心室，在预负荷稍有增加时就会显著扩张。这可能是阐明心室长期摆脱心包生理限制后的扩张性的一个线索。
