Freimark D, Czer L S, Aleksic I, Barthold C, Admon D, Trento A, Blanche C, Valenza M, Siegel R J
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048-1865, USA.
Am Heart J. 1995 Jul;130(1):121-6. doi: 10.1016/0002-8703(95)90246-5.
Orthotopic heart transplantation (OHT) with bicaval and pulmonary venous anastomoses avoids the large atrial anastomoses of the standard biatrial technique. To determine whether the bicaval technique improves atrial performance, we used Doppler echocardiography to study 13 patients with bicaval OHT, 15 with biatrial OHT, and 8 normal subjects. All were in sinus rhythm and free of rejection. Left atrial size, transmitral (M) and late diastolic (A) mitral flow velocity integrals were measured. Atrial transport (A/M, %) and atrial ejection force (kilodynes, calculated from peak A-wave velocity and mitral orifice area) were assessed. Left atrial dimensions in the bicaval (4.3 +/- 0.5 cm) and biatrial groups (4.9 +/- 0.9 cm) were larger than in controls (3.3 +/- 0.8 cm, p < 0.05). Left atrial transport (37% +/- 12% and 35% +/- 12%) and ejection force (14.1 +/- 6.9 kdyne and 10.2 +/- 7.8 kdyne) were similar in the bicaval group and controls (p not significant) but were significantly lower in the biatrial group (20% +/- 19% and 3.6 +/- 4.0 kdynes, p < 0.05). The bicaval and pulmonary venous technique of OHT produces more physiologic atrial function compared with the biatrial technique as evidenced by greater atrial ejection force and more normal atrial transport.
采用双腔静脉和肺静脉吻合的原位心脏移植（OHT）避免了标准双心房技术中的大型心房吻合。为了确定双腔静脉技术是否能改善心房功能，我们使用多普勒超声心动图研究了13例接受双腔静脉OHT的患者、15例接受双心房OHT的患者和8名正常受试者。所有患者均为窦性心律且无排斥反应。测量了左心房大小、二尖瓣跨瓣（M）和舒张晚期（A）二尖瓣血流速度积分。评估了心房传输（A/M，%）和心房射血力（达因，根据A波峰值速度和二尖瓣口面积计算）。双腔静脉组（4.3±0.5 cm）和双心房组（4.9±0.9 cm）的左心房尺寸大于对照组（3.3±0.8 cm，p<0.05）。双腔静脉组的心房传输（37%±12%和35%±12%）和射血力（14.1±6.9达因和1- 0.2±7.8达因）与对照组相似（p无显著性差异），但双心房组显著更低（20%±19%和3.6±4.0达因，p<0.05）。与双心房技术相比，OHT的双腔静脉和肺静脉技术产生更生理性的心房功能，这表现为更大的心房射血力和更正常的心房传输。
