Maagaard Marie, Heiberg Johan, Eckerström Filip, Asschenfeldt Benjamin, Rex Christian E, Ringgaard Steffen, Hjortdal Vibeke E
1Department of Cardiothoracic and Vascular Surgery,Aarhus University Hospital,Aarhus,Denmark.
3The MR Research Centre,Aarhus University Hospital,Aarhus,Denmark.
Cardiol Young. 2018 Dec;28(12):1379-1385. doi: 10.1017/S1047951118001361. Epub 2018 Aug 30.
Ventricular septal defects - large, surgically closed or small, untreated - have demonstrated lower peak exercise capacity compared with healthy controls. The mechanisms behind these findings are not yet fully understood. Therefore, we evaluated biventricular morphology in adults with a ventricular septal defect using MRI. Adults with either childhood surgically closed or small, untreated ventricular septal defects and healthy controls underwent cine MRI for the evaluation of biventricular volumes and quantitative flow scans for measurement of stroke index. Scans were analysed post hoc in a blinded manner. In total, 20 operated patients (22±2 years) and 20 healthy controls (23±2 years) were included, along with 32 patients with small, unrepaired ventricular septal defects (26±6 years) and 28 controls (27±5 years). Operated patients demonstrated larger right ventricular end-diastolic volume index (103±20 ml/m2) compared with their controls (88±16 ml/m2), p=0.01. Heart rate and right ventricular stroke index did not differ between operated patients and controls. Patients with unrepaired ventricular septal defects revealed larger right ventricular end-diastolic volume index (105±17 ml/m2) compared with their controls (88±13 ml/m2), p<0.01. Furthermore, right ventricular stroke index was higher in unrepaired ventricular septal defects (53±12 ml/minute/m2) compared with controls (46±8 ml/minute/m2), p=0.02, with similar heart rates. Both patient groups' right ventricles were visually characterised by abundant coarse trabeculation. Positive correlations were demonstrated between right ventricular end-diastolic volume indices and peak exercise capacity in patients. Left ventricle measurements displayed no differences between groups. In conclusion, altered right ventricular morphology was demonstrated in adults 20 years after surgical ventricular septal defect repair and in adults with small, untreated ventricular septal defects.
室间隔缺损——大的、已手术闭合的或小的、未治疗的——与健康对照相比，已显示出较低的运动峰值能力。这些发现背后的机制尚未完全了解。因此，我们使用磁共振成像（MRI）评估了患有室间隔缺损的成年人的双心室形态。患有儿童期手术闭合或小的、未治疗的室间隔缺损的成年人以及健康对照接受了电影MRI以评估双心室容积，并进行了定量血流扫描以测量每搏输出指数。扫描结果在事后以盲法进行分析。总共纳入了20例接受手术的患者（22±2岁）和20例健康对照（23±2岁），以及32例小的、未修复的室间隔缺损患者（26±6岁）和28例对照（27±5岁）。与对照组（88±16 ml/m²）相比，接受手术的患者表现出更大的右心室舒张末期容积指数（103±20 ml/m²），p = 0.01。接受手术的患者与对照组之间的心率和右心室每搏输出指数没有差异。与对照组（88±13 ml/m²）相比，未修复的室间隔缺损患者显示出更大的右心室舒张末期容积指数（105±17 ml/m²），p<0.01。此外，与对照组（46±8 ml/分钟/m²）相比，未修复的室间隔缺损患者的右心室每搏输出指数更高（53±12 ml/分钟/m²），p = 0.02，心率相似。两组患者的右心室在视觉上均以丰富的粗大肌小梁为特征。患者的右心室舒张末期容积指数与运动峰值能力之间存在正相关。左心室测量结果在各组之间没有差异。总之，在室间隔缺损手术修复20年后的成年人以及患有小的、未治疗的室间隔缺损的成年人中，均显示出右心室形态改变。
