Akagi T, Benson L N, Williams W G, Freedom R M
Department of Pediatrics, Variety Club Cardiac Catheterization Laboratories, Hospital for Sick Children, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1993 Oct;22(4):1182-8. doi: 10.1016/0735-1097(93)90435-4.
The purpose of this study was to determine whether wall motion abnormalities are present before or after the Fontan procedure in patients with a univentricular heart of the left ventricular type with an absent right atrioventricular valve connection (tricuspid atresia) and to assess the impact of such abnormalities on ventricular performance and clinical outcome.
Normal systolic and diastolic ventricular function is critical for a successful Fontan repair. However, there have been no previous studies addressing the relation between regional ventricular function and hemodynamic factors.
Thirty-seven pediatric patients were studied with biplane ventricular cineangiography. There were 20 male and 17 female patients whose mean age at the time of the Fontan operation was 6.5 +/- 3.5 years (range 2.5 to 15.6). Eighteen patients were studied preoperatively, 25 at > 1 year postoperatively and 6 serially. Wall motion was assessed by a centerline method. Normal ranges for wall motion and other variables were established from 25 normal subjects.
Wall motion abnormalities were observed in 2 of 18 patients preoperatively and in 11 of 25 patients postoperatively. Age at operation and ventricular volumes did not differ between postoperative patients who had normal (group I, 14 patients) or abnormal (group II, 11 patients) wall motion. However, ventricular mass and the mass/volume ratio were significantly greater and systolic variables and cardiac index were significantly lower in group II versus group I. Two patients in group I were considered to have a clinically poor outcome (persistent heart failure), and five in group II had heart failure, including one who died late.
These observations suggest that postoperative regional wall motion abnormalities in this setting are not rare, may be related to excessive hypertrophy and may contribute to cardiac dysfunction and a poor clinical outcome.
本研究旨在确定左心室型单心室且右房室瓣连接缺失（三尖瓣闭锁）的患者在Fontan手术前或术后是否存在室壁运动异常，并评估此类异常对心室功能和临床结局的影响。
正常的心室收缩和舒张功能对于Fontan修复手术的成功至关重要。然而，此前尚无研究探讨局部心室功能与血流动力学因素之间的关系。
对37例儿科患者进行了双平面心室造影研究。其中男性20例，女性17例，Fontan手术时的平均年龄为6.5±3.5岁（范围2.5至15.6岁）。18例患者在术前进行了研究，25例在术后1年以上进行了研究，6例进行了连续研究。采用中心线法评估室壁运动。从25名正常受试者中确定室壁运动及其他变量的正常范围。
术前18例患者中有2例观察到室壁运动异常，术后25例患者中有11例出现异常。手术时年龄和心室容积在室壁运动正常（I组，14例患者）或异常（II组，11例患者）的术后患者之间并无差异。然而，与I组相比，II组的心室质量和质量/容积比显著更高，收缩期变量和心脏指数显著更低。I组中有2例患者被认为临床结局较差（持续性心力衰竭），II组中有5例出现心力衰竭，其中1例晚期死亡。
这些观察结果表明，在这种情况下术后局部室壁运动异常并不罕见，可能与过度肥厚有关，并可能导致心脏功能障碍和不良临床结局。
