Seckeler Michael D, O'Leary Edward, Anitha Jayakumar K
Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA,
Pediatr Cardiol. 2015 Apr;36(4):732-6. doi: 10.1007/s00246-014-1069-1. Epub 2014 Dec 9.
Patients with single ventricle anatomy undergo staged surgical palliation which results in pulmonary and systemic circulations in series with a single systemic pump. Single right ventricular morphology has been found to be an independent risk factor for worse survival. We sought to compare patients with single left (SLV) and single right (SRV) ventricular morphology to identify hemodynamic differences that may contribute to worse survival in patients with a single right ventricular. Single center, retrospective review of invasive hemodynamic data. All patients with single ventricle anatomy who underwent superior cavo-pulmonary anastomosis (Stage 2 palliation) and/or total cavo-pulmonary anastomosis (Stage 3 palliation) from August 1995 through May 2011 were identified. Patients were compared over time, and SLV and SRV patients were compared. Seventy-nine single ventricle patients (56 % SRV) underwent staged palliation and were analyzed. There was no difference in overall mortality (12 % SLV, 11 % SRV). There was no difference in hemodynamics at pre-Stage 2 catheterization between ventricular morphology, but SRV patients had higher ventricular end-diastolic pressure at pre-Stage 3 catheterization (7.6 vs. 6.4 mmHg, p = 0.026). End-diastolic pressure decreased after Stage 2 surgery for SLV patients, but not SRV patients. Intrinsic differences in morphology, function, and response to performing as the systemic ventricle between single right and left ventricles may lead to an elevated ventricular end-diastolic pressure. This could limit passive flow through the pulmonary circuit and coronary perfusion after Stage 3 palliation and potentially lead to poorer long-term performance for SRV patients.
单心室解剖结构的患者需接受分期手术姑息治疗，这会导致肺循环和体循环通过单一的体循环泵串联起来。已发现单右心室形态是生存预后较差的独立危险因素。我们试图比较单左心室（SLV）和单右心室（SRV）形态的患者，以确定可能导致单右心室患者生存预后较差的血流动力学差异。对侵入性血流动力学数据进行单中心回顾性分析。确定了1995年8月至2011年5月期间所有接受上腔静脉-肺动脉吻合术（二期姑息治疗）和/或全腔静脉-肺动脉吻合术（三期姑息治疗）的单心室解剖结构患者。对患者进行长期比较，并比较SLV和SRV患者。79名单心室患者（56%为SRV）接受了分期姑息治疗并进行了分析。总体死亡率无差异（SLV为12%，SRV为11%）。心室形态在二期导管插入术前的血流动力学无差异，但SRV患者在三期导管插入术前的心室舒张末期压力较高（7.6对6.4 mmHg，p = 0.026）。SLV患者在二期手术后舒张末期压力下降，但SRV患者没有。单右心室和单左心室在形态、功能以及作为体循环心室的反应方面的内在差异可能导致心室舒张末期压力升高。这可能会限制三期姑息治疗后通过肺循环的被动血流和冠状动脉灌注，并可能导致SRV患者的长期表现较差。
