Choe K O, Hong Y K, Kim M J, Cho B K
Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 1996 Feb;37(1):19-30. doi: 10.3349/ymj.1996.37.1.19.
A radioisotope first pass study was done on patients over a period of 1 to 15 years (average 4.6 years) after repair for ventricular septal defect or arterial septal defect with a left to right shunt. The age of the patients ranged from 6 to 32 years (average 14.2 year) at the time of the study. The total work of exercise and the right and left ventricular ejection fraction(EF) were evaluated at rest and after exercise. The results were compared with the preoperative hemodynamic findings and with the age of patient at the time of the operation. 1) When the total work of exercise was divided with the maximal exercise capacity of the normal individual corresponding to the patients' height and body surface area (the percentage of total work), it were very low with the average of 40% of normal. There was no sexual difference, but the percentage of total work of exercise had significant correlation with the patients' age at the time of operation (r = -0.52, p < 0.01) and post-exercise left ventricular ejection fraction (LVEF)(r = -0.39, p < 0.05). 2) LVEF at rest had some correlation with the preoperative mean pulmonary arterial pressure (r = -0.29, p = 0.05), but showed no relationship with Qp/Qs or Rp/Rs ratios. The right ventricular ejection fraction (RVEF) at rest had no relations with the preoperative hemodynamic findings with maximal workload. 3) The post-exercise RVEF showed linear correlation with the preoperative Rp/Rs ratio (r = -0.49, p < 0.005), and mean pulmonary arterial pressure (r = -0.37, p < 0.05). The post-exercise LVEF had no significant correlation with any preoperative hemodynamic factors. 4) When greater than 5% increase in ventricular EF after exercise is considered normal, the group with the normal right and left ventricular responses (n = 11) showed normal preoperative Rp/Rs ratio (7.6 +/- 4.1). In the group with normal left, but abnormal right ventricular response (n = 9) and the group with abnormal biventricular response (n = 11), both demonstrated incremental increase in Rp/Rs ratio (20.1 +/- 11.3, 26.3 +/- 19.8 respectively). Normal right, but abnormal left ventricular reaction (n = 2) was noted in patients with residual aortic valvular insufficiency and residual ventricular septal defect. In conclusion, post-operative ventricular response was much more sensitive and informative than that of ventricular function at rest and to detect subclinical cardiac dysfunction. Post-exercise RVEF was closely correlated with preoperative pulmonary vascular hemodynamics, while post-exercise LVEF seemed to be a major determinant of working capacity after repair.
对室间隔缺损或房间隔缺损伴左向右分流修补术后1至15年（平均4.6年）的患者进行了放射性核素首次通过研究。研究时患者年龄在6至32岁之间（平均14.2岁）。在静息和运动后评估运动总功以及左右心室射血分数（EF）。将结果与术前血流动力学结果以及手术时患者年龄进行比较。1）当运动总功除以与患者身高和体表面积相对应的正常个体的最大运动能力（总功百分比）时，该值非常低，平均为正常的40%。无性别差异，但运动总功百分比与手术时患者年龄显著相关（r = -0.52，p < 0.01）以及运动后左心室射血分数（LVEF）显著相关（r = -0.39，p < 0.05）。2）静息时LVEF与术前平均肺动脉压有一定相关性（r = -0.29，p = 0.05），但与Qp/Qs或Rp/Rs比值无关。静息时右心室射血分数（RVEF）与术前最大工作量时的血流动力学结果无关。3）运动后RVEF与术前Rp/Rs比值呈线性相关（r = -0.49，p < 0.005）以及与平均肺动脉压呈线性相关（r = -0.37，p < 0.05）。运动后LVEF与任何术前血流动力学因素均无显著相关性。4）当运动后心室EF增加大于5%被认为正常时，左右心室反应正常的组（n = 11）术前Rp/Rs比值正常（7.6 +/- 4.1）。在左心室正常但右心室反应异常的组（n = 9）和双心室反应异常的组（n = 11）中，两者Rp/Rs比值均呈递增（分别为20.1 +/- 11.3，26.3 +/- 19.8）。在有残余主动脉瓣关闭不全和残余室间隔缺损的患者中发现右心室正常但左心室反应异常（n = 2）。总之，术后心室反应比静息时的心室功能更敏感且更具信息价值，有助于检测亚临床心脏功能障碍。运动后RVEF与术前肺血管血流动力学密切相关，而运动后LVEF似乎是修补术后工作能力的主要决定因素。
