Guillaumont S, Counil F, Dumas R, Voisin M, Prefaut C
Service de pédiatrie 1, CHU Arnaud-de-Villeneuve, Montpellier.
Arch Mal Coeur Vaiss. 1996 May;89(5):587-92.
The aim of this study was to assess cardiac adaptation to muscular exercise in children operated for tetralogy of Fallot. Eight children with a history of tetralogy of Fallot were studied and compared with ten control children. The basal evaluation consisted of an electrocardiogram, spirometry in all cases. Chest X-ray and echocardiography in all operated children. A muscular exercise stress test with incremental load on a bicycle ergometer was carried out with measurement of the cardiac output by CO2 rebreathing (experimental method). Under resting conditions, the two groups were comparable with respect to anthropometrical parameters and respiratory function. The cardiovascular data confirmed the good postoperative results of the children with a history of tetralogy of Fallot; cardiothoracic index of 0.49 to 0.55; sinus rhythm on the electrocardiogram; right ventricular pressures within normal limits; residual instantaneous right ventricular-pulmonary artery pressure gradient less than 25 mmH. On exercise, there was no significant difference with respect to VO2max, maximal heart rate, maximal cardiac output and maximal ventilation. The relationship between cardiac output and oxygen consumption was linear in two groups: y = 8.17x + 1.95 in the control group, y = 8.57x + 2.82 in the operated children. The change in cardiac output on exercise was comparable in the two groups. These observations seemed to be related to the good postoperative haemodynamic result: absence of pulmonary sequellae and right ventricular dysfunction. Despite the normality of the results obtained in this series, exercise stress testing with analysis of cardiac and respiratory adaptation would seem to be necessary in the follow-up of children operated for tetralogy of Fallot to exclude a ventilatory or circulatory limitation.
本研究的目的是评估法洛四联症手术患儿心脏对肌肉运动的适应性。对8名有法洛四联症病史的儿童进行了研究，并与10名对照儿童进行了比较。基础评估包括所有病例的心电图、肺活量测定。所有手术患儿均进行了胸部X线和超声心动图检查。通过二氧化碳重呼吸法（实验方法）测量心输出量，在自行车测力计上进行递增负荷的肌肉运动应激试验。在静息状态下，两组在人体测量参数和呼吸功能方面具有可比性。心血管数据证实了有法洛四联症病史患儿良好的术后结果；心胸指数为0.49至0.55；心电图显示窦性心律；右心室压力在正常范围内；残余瞬时右心室-肺动脉压力梯度小于25 mmHg。运动时，两组在最大摄氧量、最大心率、最大心输出量和最大通气量方面无显著差异。两组的心输出量与耗氧量之间呈线性关系：对照组为y = 8.17x + 1.95，手术患儿为y = 8.57x + 2.82。两组运动时的心输出量变化相当。这些观察结果似乎与良好的术后血流动力学结果有关：无肺部后遗症和右心室功能障碍。尽管本系列获得的结果正常，但对于法洛四联症手术患儿的随访，进行运动应激试验并分析心脏和呼吸适应性似乎有必要，以排除通气或循环受限情况。
