Rocchini A P
Am J Cardiol. 1981 Aug;48(2):325-30. doi: 10.1016/0002-9149(81)90614-7.
The exercise hemodynamic values in two groups of patients with repaired tetrad of Fallot (eight patients with some residual pulmonary insufficiency and seven patients without insufficiency) were compared with values in seven patients with trivial pulmonary stenosis who had not been operated on. The patients with tetrad of Fallot underwent surgery after age 8 years and all had a good hemodynamic repair (no shunts and a right ventricular systolic pressure at rest of less than 60 mm Hg). Exercise increased the right ventricular outflow tract gradient by the same magnitude in all three groups of patients. However, both surgically treated groups experienced impaired cardiac pump function on supine exercise (that is, a lower than anticipated cardiac index for the amount of oxygen consumed and a significant decrease in stroke index). Exercise also caused both groups with repair to have a decrease in stroke index and a concomitant increase in right ventricular end-diastolic and pulmonary wedge pressures; in contrast, the patients with pulmonary arterial stenosis had an increase in stroke index and a concomitant decrease in right ventricular end-diastolic and pulmonary wedge pressures. These findings indicate that an impaired cardiac response to supine exercise can occur in patients in whom intracardiac repair of tetrad of Fallot was performed after early childhood, even though they have had a good hemodynamic repair. In addition, the impaired cardiac response to supine exercise in these patients was probably due largely to an altered myocardial compliance rather than to either residual pulmonary stenosis or pulmonary insufficiency.
将两组法洛四联症修复术后患者（8例有一定残余肺功能不全和7例无肺功能不全）的运动血流动力学值与7例未接受手术的轻度肺动脉狭窄患者的值进行比较。法洛四联症患者在8岁以后接受手术，所有患者均有良好的血流动力学修复（无分流，静息时右心室收缩压低于60 mmHg）。运动使所有三组患者的右心室流出道梯度增加相同幅度。然而，两个手术治疗组在仰卧运动时心脏泵功能受损（即，对于所消耗的氧量，心脏指数低于预期，且每搏输出量指数显著下降）。运动还导致两组修复患者的每搏输出量指数下降，同时右心室舒张末期压力和肺楔压升高；相比之下，肺动脉狭窄患者的每搏输出量指数增加，同时右心室舒张末期压力和肺楔压下降。这些发现表明，即使在幼儿期后进行了法洛四联症的心内修复且血流动力学修复良好的患者中，仰卧运动时心脏反应受损也可能发生。此外，这些患者仰卧运动时心脏反应受损可能主要是由于心肌顺应性改变，而非残余肺动脉狭窄或肺功能不全。
