Ho Jason G, Schamberger Marcus S, Hurwitz Roger A, Johnson Tiffanie R, Sterrett Lauren E, Ebenroth Eric S
Section of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, 699 Riley Hospital Drive, RR 127, Indianapolis, IN, 46202, USA,
Pediatr Cardiol. 2015 Aug;36(6):1194-203. doi: 10.1007/s00246-015-1143-3. Epub 2015 Mar 10.
Patients may develop hemodynamic abnormalities after right ventricular outflow tract (RVOT) repair. Re-intervention timing remains a dilemma. This study evaluates exercise capacity and RV function before and after intervention using age-related comparisons. Twenty-six patients with severe pulmonary regurgitation (PR) after initial repair scheduled for pulmonary valve replacement (PVR) were enrolled. Metabolic treadmill testing (EST) and MRI were obtained before and after surgery. EST results were compared with matched controls. Preoperative exercise time and peak oxygen consumption (VO2 max) were significantly diminished compared with controls but were not significantly different postoperatively. The patients were then split into age-related cohorts. When comparing pre-PVR and post-PVR exercise time and VO2 max among themselves, neither cohort showed significant differences. However, patients younger than 25 years had better postoperative results, an age-related difference not seen in the controls. Preoperative MRI showed significantly dilated RV, PR, and low normal function. After PVR, the right to left ventricular end-diastolic volume ratio (RVEDV:LVEDV) and pulmonary artery regurgitant fraction (RF) significantly decreased. There was no change in ventricular ejection fractions (EF). Severe PR, decreased RVEF, and RV dilation can significantly diminish exercise capacity. PVR improves RVEDV:LVEDV and RF, but not EF. Younger patients had better exercise capacity that was maintained postoperatively. This age-related difference was not seen in the controls, indicating that earlier intervention may preserve exercise capacity. Serial ESTs in patients with severe PR following RVOT repair may identify deteriorating exercise capacity as an early indicator for the need for PVR.
右心室流出道（RVOT）修复术后患者可能会出现血流动力学异常。再次干预的时机仍然是一个难题。本研究通过年龄相关比较评估干预前后的运动能力和右心室功能。纳入了26例初次修复后计划进行肺动脉瓣置换术（PVR）的重度肺动脉反流（PR）患者。在手术前后进行了代谢平板运动试验（EST）和磁共振成像（MRI）检查。将EST结果与匹配的对照组进行比较。与对照组相比，术前运动时间和峰值耗氧量（VO2 max）显著降低，但术后无显著差异。然后将患者分为年龄相关队列。在比较PVR术前和术后队列自身的运动时间和VO2 max时，两个队列均未显示出显著差异。然而，年龄小于25岁的患者术后结果更好，这是对照组未出现的年龄相关差异。术前MRI显示右心室显著扩张、PR及功能略低于正常。PVR术后，右心室与左心室舒张末期容积比（RVEDV:LVEDV）和肺动脉反流分数（RF）显著降低。心室射血分数（EF）无变化。重度PR、右心室射血分数降低和右心室扩张可显著降低运动能力。PVR可改善RVEDV:LVEDV和RF，但不能改善EF。年轻患者的运动能力更好，且术后得以维持。对照组未出现这种年龄相关差异，表明早期干预可能保留运动能力。RVOT修复术后重度PR患者的系列EST检查可能会发现运动能力下降是PVR需求的早期指标。
