Donofrio M T, Jacobs M L, Norwood W I, Rychik J
Division of Cardiology, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
J Am Coll Cardiol. 1995 Oct;26(4):1008-15. doi: 10.1016/0735-1097(95)00241-5.
This study investigated the phenomenon of, and the relation between, alterations in ventricular geometry after acute surgical volume unloading of the ventricle and the development of subaortic stenosis in patients with a single ventricle and ventricular septal defect-dependent systemic flow.
Subaortic outflow obstruction has been observed to occur in patients with a single left ventricle after placement of a pulmonary artery band. The timing and etiology of this phenomenon are not well defined.
The preoperative and postoperative echocardiograms of 18 patients 14.9 +/- 22.8 months old (mean +/- SD) with a diagnosis of single left ventricle who underwent pulmonary artery banding or cavopulmonary connection were reviewed. Postoperative studies were performed a mean of 7.0 +/- 6.5 days after operation. The ventricular septal defect diameter was measured in two orthogonal views and the area calculated using the formula for an ellipse. Interventricular septal and posterior wall thickness and left ventricular diameter and length were also measured.
Mean ventricular septal defect area indexed to body surface area diminished by 36 +/- 23% (3.1 +/- 2.7 to 2.0 +/- 1.8 cm2/m2, p < 0.01). Mean interventricular septal and posterior wall thickness increased significantly, and left ventricular diameter and length decreased significantly. A greater diminution in ventricular septal defect area was noted after cavopulmonary connection (41 +/- 19%, p < 0.01) than after pulmonary artery banding (25 +/- 28%, p = 0.22).
In the single left ventricle, diminution in ventricular septal defect size occurs early and is related to an acute alteration in ventricular geometry that accompanies the decrease in ventricular volume. Ventricular septal defect diminution was greater after volume unloading of the ventricle after cavopulmonary connection than after pulmonary artery banding.
本研究调查了单心室合并室间隔缺损依赖体循环血流的患者在急性外科心室容量卸载后心室几何形态改变的现象及其与主动脉下狭窄发展之间的关系。
在肺动脉束带置入后，观察到单左心室患者出现主动脉下流出道梗阻。这种现象的发生时间和病因尚不明确。
回顾了18例诊断为单左心室且年龄为14.9±22.8个月（平均±标准差）的患者的术前和术后超声心动图，这些患者接受了肺动脉束带术或腔肺连接术。术后研究平均在术后7.0±6.5天进行。在两个正交视图中测量室间隔缺损直径，并使用椭圆公式计算面积。还测量了室间隔和后壁厚度以及左心室直径和长度。
以体表面积指数化的平均室间隔缺损面积减少了36±23%（从3.1±2.7降至2.0±1.8 cm2/m2，p<0.01）。平均室间隔和后壁厚度显著增加，左心室直径和长度显著减小。与肺动脉束带术后（25±28%，p=0.22）相比，腔肺连接术后室间隔缺损面积的减小更为明显（41±19%，p<0.01）。
在单左心室中，室间隔缺损大小的减小发生较早，且与心室容量减少伴随的心室几何形态急性改变有关。与肺动脉束带术后相比，腔肺连接术后心室容量卸载后室间隔缺损的减小更为明显。
