Cortes R G, Satomi G, Yoshigi M, Momma K
Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Pediatr Cardiol. 1994 Jul-Aug;15(4):170-7. doi: 10.1007/BF00800671.
After undergoing the Fontan procedure for congenital heart disease, 16 young patients performed a maximal treadmill test according to the Bruce protocol. The peak velocity of the blood flow in the ascending aorta, stroke index, and cardiac index were measured by continuous-wave Doppler echocardiography at rest and at each stage of the test. The results were compared with those from 18 normal children. The body surface area was similar in the two groups. The endurance time was 37% shorter in the Fontan group than in the control group. From the beginning of exercise until the sixth minute, the increase in stroke index was lower in the Fontan group (NS). After that point, the stroke index was maintained at a high level in the control group but decreased toward its original level in the Fontan group. The response of cardiac index to exercise in the two groups was comparable until the sixth minute, after which the Fontan group failed to maintain an ascending curve. All the hemodynamic values were significantly higher in the control group at maximal exercise; at this point the cardiac index had increased 79% in the Fontan group and 170% in the control group. The subnormal response of the stroke volume at submaximal exercise and the subsequent decrease at maximal exercise following the Fontan procedure are important hemodynamic findings.
16名先天性心脏病患者接受Fontan手术后，按照布鲁斯方案进行了极限平板运动试验。在静息状态及试验的每个阶段，通过连续波多普勒超声心动图测量升主动脉血流峰值速度、每搏输出指数和心脏指数。将结果与18名正常儿童的结果进行比较。两组的体表面积相似。Fontan组的耐力时间比对照组短37%。从运动开始到第六分钟，Fontan组每搏输出指数的增加较低（无统计学差异）。此后，对照组的每搏输出指数维持在较高水平，而Fontan组则降至初始水平。两组心脏指数对运动的反应在第六分钟前相当，此后Fontan组未能维持上升曲线。在最大运动时，对照组的所有血流动力学值均显著更高；此时，Fontan组的心脏指数增加了79%，对照组增加了170%。Fontan手术后次最大运动时每搏量反应异常及随后最大运动时每搏量下降是重要的血流动力学发现。
