Moller Thomas, Lindberg Harald, Lund May Brit, Holmstrom Henrik, Dohlen Gaute, Thaulow Erik
1Department of Paediatric Cardiology,Oslo University Hospital,Oslo,Norway.
2Institute of Clinical Medicine, Faculty of Medicine,University of Oslo,Oslo,Norway.
Cardiol Young. 2018 Jun;28(6):797-803. doi: 10.1017/S1047951117002979. Epub 2018 Mar 6.
We previously demonstrated an abnormally high right ventricular systolic pressure response to exercise in 50% of adolescents operated on for isolated ventricular septal defect. The present study investigated the prevalence of abnormal right ventricular systolic pressure response in 20 adult (age 30-45 years) patients who underwent surgery for early ventricular septal defect closure and its association with impaired ventricular function, pulmonary function, or exercise capacity. The patients underwent cardiopulmonary tests, including exercise stress echocardiography. Five of 19 patients (26%) presented an abnormal right ventricular systolic pressure response to exercise ⩾ 52 mmHg. Right ventricular systolic function was mixed, with normal tricuspid annular plane systolic excursion and fractional area change, but abnormal tricuspid annular systolic motion velocity (median 6.7 cm/second) and isovolumetric acceleration (median 0.8 m/second2). Left ventricular systolic and diastolic function was normal at rest as measured by the peak systolic velocity of the lateral wall and isovolumic acceleration, early diastolic velocity, and ratio of early diastolic flow to tissue velocity, except for ejection fraction (median 53%). The myocardial performance index was abnormal for both the left and right ventricle. Peak oxygen uptake was normal (mean z score -0.4, 95% CI -2.8-0.3). There was no association between an abnormal right ventricular systolic pressure response during exercise and right or left ventricular function, pulmonary function, or exercise capacity. Abnormal right ventricular pressure response is not more frequent in adult patients compared with adolescents. This does not support the theory of progressive pulmonary vascular disease following closure of left-to-right shunts.
我们之前证明，在接受单纯室间隔缺损手术的青少年中，50% 的人对运动的右心室收缩压反应异常高。本研究调查了 20 名成年（年龄 30 - 45 岁）患者中右心室收缩压反应异常的患病率，这些患者因早期室间隔缺损关闭而接受手术，以及其与心室功能受损、肺功能或运动能力的关联。患者接受了心肺测试，包括运动负荷超声心动图检查。19 名患者中有 5 名（26%）对运动的右心室收缩压反应异常⩾52 mmHg。右心室收缩功能混合，三尖瓣环平面收缩期位移和面积变化分数正常，但三尖瓣环收缩运动速度异常（中位数 6.7 cm/秒）和等容加速异常（中位数 0.8 m/秒²）。通过侧壁的收缩期峰值速度、等容加速、舒张早期速度以及舒张早期血流与组织速度之比测量，静息时左心室收缩和舒张功能正常，但射血分数除外（中位数 53%）。左右心室的心肌性能指数均异常。峰值摄氧量正常（平均 z 评分 -0.4，95%CI -2.8 - 0.3）。运动期间右心室收缩压反应异常与右或左心室功能、肺功能或运动能力之间无关联。与青少年相比，成年患者中右心室压力反应异常并不更常见。这并不支持左向右分流关闭后进行性肺血管疾病的理论。
