Naoum Christopher, Kritharides Leonard, Gnanenthiran Sonali R, Martin David, Falk Gregory L, Yiannikas John
Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Department of Upper Gastrointestinal Surgery, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Echocardiography. 2017 Sep;34(9):1305-1314. doi: 10.1111/echo.13628. Epub 2017 Jul 18.
Hiatal hernia (HH) can cause left atrial (LA) compression and impair LA filling. We evaluated the cardiac effects of preload reduction and abdominal strain induced by Valsalva maneuver (VM) in large HH patients.
LA and left ventricular (LV) dimensions were measured using 2D transthoracic echocardiography at rest and during VM in HH patients (n=55, 70±10 years) and controls (n=22, 67±6 years). Biplane LV volumes (n=39) and mitral inflow pulse-wave Doppler parameters (n=27) were also evaluated. In HH patients, resting LA compression was graded qualitatively (none-mild or moderate-severe).
In both controls and HH patients, VM significantly decreased LA (controls, 19±2 vs 16±3 mm/m ; HH, 16±5 vs 9±5 mm/m ) and LV diameters (22±3 vs 19±3 mm/m ; 21±3 vs 17±3 mm/m ) and LV volume (38±8 vs 26±10 mL/m ; 31±8 vs 19±9 mL/m ) (P<.001 for all). VM decreased LA diameter significantly more in HH patients than controls (-42% vs -16%, P<.001). HH patients with none-mild resting LA compression exhibited significantly greater LA diameter reduction than controls (-38±23% vs -16±13% P=.0003) despite similar resting LA diameters. LV volumes were similarly decreased by VM in HH patients and controls irrespective of resting LA compression severity indicating relative preservation of LV filling. LA diameter correlated inversely with early diastolic filling velocity during VM in HH patients (R=-.43, P=.03) but not controls (R=.18, P=.43).
VM can markedly exacerbate LA compression in HH patients; however, LV filling is relatively less affected possibly due to augmented early diastolic filling. Conditions associated with decreased preload and increased intra-abdominal pressure may exacerbate the cardiac effects of large HH.
食管裂孔疝（HH）可导致左心房（LA）受压并损害左心房充盈。我们评估了瓦尔萨尔瓦动作（VM）引起的前负荷降低和腹内压对大型HH患者心脏的影响。
在静息状态和VM期间，使用二维经胸超声心动图测量HH患者（n = 55，70±10岁）和对照组（n = 22，67±6岁）的左心房和左心室（LV）尺寸。还评估了双平面左心室容积（n = 39）和二尖瓣流入脉冲波多普勒参数（n = 27）。在HH患者中，对静息时左心房受压情况进行定性分级（无-轻度或中度-重度）。
在对照组和HH患者中，VM均显著降低了左心房（对照组，19±2 vs 16±3 mm/m；HH，16±5 vs 9±5 mm/m）和左心室直径（22±3 vs 19±3 mm/m；21±3 vs 17±3 mm/m）以及左心室容积（38±8 vs 26±10 mL/m；31±8 vs 19±9 mL/m）（所有P<.001）。VM使HH患者的左心房直径降低幅度显著大于对照组（-42% vs -16%，P<.001）。尽管静息时左心房直径相似，但静息时无-轻度左心房受压的HH患者左心房直径减小幅度显著大于对照组（-38±23% vs -16±13%，P =.0003）。无论静息时左心房受压严重程度如何，VM均使HH患者和对照组的左心室容积同样减小，表明左心室充盈相对保持。在HH患者中，左心房直径与VM期间的舒张早期充盈速度呈负相关（R = -.43，P =.03），而在对照组中无相关性（R =.
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