Chin A J, Franklin W H, Andrews B A, Norwood W I
Division of Cardiology, Children's Hospital of Philadelphia, Pennsylvania 19104.
Ann Thorac Surg. 1993 Dec;56(6):1359-65. doi: 10.1016/0003-4975(93)90682-8.
Acute removal of a ventricular volume overload, in the face of relatively unchanging ventricular mass, results in geometric alterations that can impair diastolic ventricular performance after Fontan operation. We investigated whether geometric alterations were (1) more severe after Fontan operation than after hemi-Fontan operation, (2) more severe in infants than in children, and (3) more severe in the morphologic right ventricle than in the morphologic left ventricle. We studied 22 patients, 11 with hypoplastic left heart syndrome and 11 with a functionally single morphologic left ventricle. After Fontan operation, right ventricular end-diastolic volume declined by 52% from 36.6 +/- 12.2 to 17.5 +/- 9.3 mL. Right ventricular wall thickness increased from 6.8 +/- 1.3 to 7.5 +/- 1.8 mm. Left ventricular end-diastolic volume diminished by 40% from 57.6 +/- 23.3 to 34.8 +/- 17.6 mL. Left ventricular wall thickness increased from 7.0 +/- 2.1 to 8.7 +/- 1.9 mm. The alterations in right ventricular geometry are more marked early after Fontan operation than early after the hemi-Fontan procedure. Geometric alterations in the left ventricle appear to be more severe in infants than in children. Finally, alterations in the morphologic right ventricle appear to be of similar magnitude to those in the morphologic left ventricle.
在心室质量相对不变的情况下，急性消除心室容量超负荷会导致几何形状改变，这可能会损害Fontan手术后的心室舒张功能。我们研究了几何形状改变是否：（1）Fontan手术后比半Fontan手术后更严重；（2）婴儿比儿童更严重；（3）形态学右心室比形态学左心室更严重。我们研究了22例患者，其中11例患有左心发育不全综合征，11例具有功能上单一的形态学左心室。Fontan手术后，右心室舒张末期容积从36.6±12.2 mL下降52%至17.5±9.3 mL。右心室壁厚度从6.8±1.3 mm增加到7.5±1.8 mm。左心室舒张末期容积从57.6±23.3 mL减少40%至34.8±17.6 mL。左心室壁厚度从7.0±2.1 mm增加到8.7±1.9 mm。Fontan手术后早期右心室几何形状的改变比半Fontan手术后早期更明显。婴儿左心室的几何形状改变似乎比儿童更严重。最后，形态学右心室的改变似乎与形态学左心室的改变程度相似。
