Bush A, Busst C M, Haworth S G, Hislop A A, Knight W B, Corrin B, Shinebourne E A
Brompton Hospital, Cardiothoracic Institute, London.
Br Heart J. 1988 Apr;59(4):480-5. doi: 10.1136/hrt.59.4.480.
Pulmonary vascular resistance was measured in air, oxygen, and after administration of vasodilators in 14 children with pulmonary hypertension and congenital heart disease. Lung morphology was examined by light microscopy and assessed quantitatively. In this selected group of patients (a) medial muscle thickness of greater than 20% in the intra-acinar arteries and Heath-Edwards changes of I or II were significantly associated with perioperative death from pulmonary complications after cardiac surgery; (b) children with lower percentage medial muscle thickness had a higher baseline resistance (r = -0.84) associated with Heath-Edwards grade III or higher changes (most of these patients were not offered corrective surgery); (c) when the lowest pulmonary vascular resistance was less than 3 units, Heath-Edwards grading was I or II (n = 4). When the pulmonary vascular resistance was greater than 6 units, however, there was no direct correlation with Heath-Edwards grading (n = 9). Four patients with a resistance of greater than 6 units had only grade I or II changes. Three had a medial muscle thickness above 20%, and were among those who died at or soon after operation. It is concluded that (a) patients with a lowest pulmonary vascular resistance of greater than 6 units have a bad prognosis whatever their lung morphology; and (b) some patients with Heath-Edwards grade I or II will have a high resistance (this group has a high medial muscle mass and a poor prognosis and would not be detected by Heath-Edwards grading alone).
对14例患有肺动脉高压和先天性心脏病的儿童，在空气中、吸氧时以及给予血管扩张剂后测量其肺血管阻力。通过光学显微镜检查肺形态并进行定量评估。在这组选定的患者中：(a) 腺泡内动脉中膜肌层厚度大于20%以及希思-爱德华兹I级或II级改变与心脏手术后因肺部并发症导致的围手术期死亡显著相关；(b) 中膜肌层厚度百分比较低的儿童基线阻力较高（r = -0.84），与希思-爱德华兹III级或更高等级改变相关（这些患者中的大多数未接受矫正手术）；(c) 当最低肺血管阻力小于3单位时，希思-爱德华兹分级为I级或II级（n = 4）。然而，当肺血管阻力大于6单位时，与希思-爱德华兹分级无直接相关性（n = 9）。4例阻力大于6单位的患者仅有I级或II级改变。3例中膜肌层厚度超过20%，属于术后或术后不久死亡的患者。结论为：(a) 最低肺血管阻力大于6单位的患者无论其肺形态如何，预后均较差；(b) 一些希思-爱德华兹I级或II级的患者会有高阻力（该组中膜肌质量高且预后差，仅靠希思-爱德华兹分级无法检测到）。
