当代Fontan手术患者的心室功能与心脏储备
Ventricular function and cardiac reserve in contemporary Fontan patients.
作者信息
Bossers S S M, Kapusta L, Kuipers I M, van Iperen G, Moelker A, Kroft L J M, Romeih S, de Rijke Y, Ten Harkel A D J, Helbing W A
机构信息
Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Pediatric Cardiology, Radboud University Medical Centre - Amalia Children's Hospital, Nijmegen, The Netherlands,; Department of Pediatrics, Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
出版信息
Int J Cardiol. 2015 Oct 1;196:73-80. doi: 10.1016/j.ijcard.2015.05.181. Epub 2015 Jun 3.
BACKGROUND/OBJECTIVE: Total cavopulmonary connection (TCPC) has been the preferred treatment for patients with univentricular hearts. Current TCPC-techniques are the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC). We aimed to determine ventricular function during rest and stress, and to compare results for both techniques and for left (LV) versus right ventricular (RV) dominance.
METHODS
99 patients, aged 12.5 ± 4.0 years underwent echocardiography and magnetic resonance imaging (MRI), and 69 patients underwent stress MRI.
RESULTS
Echocardiography showed impaired systolic and diastolic function. MRI parameters were comparable between ILT and ECC at rest. During dobutamine there was a decrease in end-diastolic volume (EDVi) (91 ± 21 vs. 80 ± 20 ml/m(2) p<0.001). Ejection fraction (EF) and cardiac index (CI) during dobutamine were lower for ILT patients (59 ± 11 (ILT) vs. 64 ± 7% (ECC), p=0.027 and 4.2 ± 1.0 (ILT) vs. 4.9 ± 1.0L/min/m(2) (ECC), p=0.006), whereas other parameters were comparable. TEI-index was higher in ILT-patients (0.72 ± 0.27 (ILT) vs. 0.56 ± 0.22 (ECC), p=0.002). Diastolic function was frequently impaired in patients with a dominant RV (67% (RV) vs. 39% (LV), p=0.011). Patients with dominant LV's had smaller end-systolic volume (ESVi) (40 ± 13 (LV) vs. 47 ± 16 (RV) ml/m(2), p=0.030) and higher EF (55 ± 8 (LV) vs. 49 ± 9 ml/m(2) (RV), p=0.001) and contractility (2.3 ± 0.8 (LV) vs. 1.9 ± 0.7 mmHg/ml/m(2) (RV), p=0.050) during rest and higher EF during dobutamine (63 ± 8 (LV) vs. 58 ± 10 ml/m(2) (RV), p=0.043).
CONCLUSION
Ventricular function is relatively well preserved in modern-day Fontan patients. With dobutamine stress there is a decrease in EDVi. ECC patients have higher CI and EF during stress. Patients with a dominant RV have lower systolic, including impaired contractility, and diastolic function.
背景/目的：全腔静脉肺动脉连接术（TCPC）一直是单心室心脏患者的首选治疗方法。目前的TCPC技术包括心房内侧面隧道术（ILT）和心外管道术（ECC）。我们旨在确定静息和应激状态下的心室功能，并比较这两种技术以及左心室（LV）优势与右心室（RV）优势的结果。
方法
99例年龄为12.5±4.0岁的患者接受了超声心动图和磁共振成像（MRI）检查，69例患者接受了应激MRI检查。
结果
超声心动图显示收缩和舒张功能受损。静息时ILT和ECC的MRI参数相当。在多巴酚丁胺负荷试验期间，舒张末期容积（EDVi）降低（91±21 vs. 80±20 ml/m²，p<0.001）。ILT患者在多巴酚丁胺负荷试验期间的射血分数（EF）和心脏指数（CI）较低（59±11（ILT）vs. 64±7%（ECC），p=0.027；4.2±1.0（ILT）vs. 4.9±1.0L/min/m²（ECC），p=0.006），而其他参数相当。ILT患者的TEI指数较高（0.72±0.27（ILT）vs. 0.56±0.22（ECC），p=0.002）。右心室优势患者的舒张功能经常受损（67%（RV）vs. 39%（LV），p=0.011）。左心室优势患者的收缩末期容积（ESVi）较小（40±13（LV）vs. 47±16（RV）ml/m²，p=0.030），静息时EF和收缩性较高（55±8（LV）vs. 49±9 ml/m²（RV），p=0.001；2.3±0.8（LV）vs. 1.9±0.7 mmHg/ml/m²（RV），p=0.050），多巴酚丁胺负荷试验期间EF也较高（63±8（LV）vs. 58±10 ml/m²（RV），p=0.043）。
结论
现代Fontan手术患者的心室功能相对保存良好。在多巴酚丁胺应激状态下EDVi降低。ECC患者在应激时CI和EF较高。右心室优势患者收缩功能较低，包括收缩性受损，舒张功能也受损。
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