Seliem M A, Baffa J M, Vetter J M, Chen S L, Chin A J, Norwood W I
Division of Cardiology, Children's Hospital of Philadelphia, PA 19104.
Ann Thorac Surg. 1993 Jun;55(6):1508-12. doi: 10.1016/0003-4975(93)91099-9.
To document and quantitate changes in right ventricular (RV) geometry and heart rate, we prospectively examined 35 consecutive patients with hypoplastic left heart syndrome under steady-state conditions (chloral hydrate sedation) before and after a bidirectional cavopulmonary anastomosis (hemi-Fontan) procedure. Right ventricular end-diastolic volume (RVEDV) was calculated as the product of RV cavity areas in two orthogonal planes divided by RV maximal length in either plane. After the hemi-Fontan procedure, RVEDV decreased by 33% from 33 +/- 13 to 22 +/- 11 mL (mean +/- standard deviation). Indexed RVEDV decreased from 86 +/- 37 to 57 +/- 28 mL/m2. The RV wall thickness at the diaphragm in subcostal frontal view (RVWD) increased by only 11% from 8 +/- 0.2 to 9 +/- 0.2 mm (p = not significant), but RVWD/RVEDV increased by 111% from 0.36 +/- 0.22 to 0.76 +/- 0.69 mm/mL (p = 0.002). The RV anterior wall thickness in subcostal sagittal view (RVWA) increased by only 13% from 7 +/- 0.2 to 8 +/- 0.2 mm (p = not significant), but RVWA/RVEDV increased by 103% from 0.31 +/- 0.20 to 0.63 +/- 0.54 mm/mL (p = 0.002). In 11 of 35 patients (31%), resting heart rate did not change (118 +/- 14 versus 108 +/- 9 beats/min; p = not significant); however, in 24 of 35 patients (69%), heart rate increased significantly (108 +/- 9 versus 127 +/- 10 beats/min; p = 0.05). In conclusion, RV wall thickness is high before the hemi-Fontan procedure and increases slightly in the first postoperative week.(ABSTRACT TRUNCATED AT 250 WORDS)
为记录和量化右心室（RV）几何形状及心率的变化，我们前瞻性地检查了35例连续性左心发育不全综合征患者，在双向腔肺吻合术（半Fontan手术）前后的稳态条件下（水合氯醛镇静）进行观察。右心室舒张末期容积（RVEDV）通过两个正交平面的右心室腔面积之积除以任一平面的右心室最大长度来计算。半Fontan手术后，RVEDV从33±13 mL降至22±11 mL，下降了33%（平均值±标准差）。校正后的RVEDV从86±37 mL/m²降至57±28 mL/m²。肋下前视图中膈肌处的右心室壁厚度（RVWD）仅从8±0.2 mm增加到9±0.2 mm，增加了11%（p值无统计学意义），但RVWD/RVEDV从0.36±0.22 mm/mL增加到0.76±0.69 mm/mL，增加了111%（p = 0.002）。肋下矢状视图中的右心室前壁厚度（RVWA）仅从7±0.2 mm增加到8±0.2 mm，增加了13%（p值无统计学意义），但RVWA/RVEDV从0.31±0.20 mm/mL增加到0.63±0.54 mm/mL，增加了103%（p = 0.002）。35例患者中有11例（31%）静息心率未改变（118±14次/分钟对108±9次/分钟；p值无统计学意义）；然而，35例患者中有24例（69%）心率显著增加（108±9次/分钟对127±10次/分钟；p = 0.05）。总之，半Fontan手术前右心室壁厚度较高，术后第一周略有增加。（摘要截短于250字）
