Douard H, Labbé L, Barat J L, Broustet J P, Baudet E, Choussat A
Cardiology Department of Hôpital Cardiologique Haut Lévèque, Pessac, France.
Chest. 1997 Jan;111(1):23-9. doi: 10.1378/chest.111.1.23.
This study reports on the cardiorespiratory response to graded exercise in patients after venous switch operation for transposition of the great arteries.
Several small studies have documented a diminished exercise tolerance after Mustard repair for transposition of the great arteries, little information exists, however, about long-term cardiorespiratory exercise performance in patients who have had the Senning procedure.
This prospective study reports on the serial long-term (mean, 11 +/- 2.8 years) cardiopulmonary exercise performance of 43 patients (age, 12 +/- 3.1 years) who underwent a Senning procedure, with no significant postoperative abnormalities. Forty-three matched healthy children were also studied as a control group.
All underwent exercise testing (Bruce protocol) with metabolic gas exchange to determine parameters at 3 min, anaerobic threshold, similar heart rate (150 beats/min), and peak exercise. Time of exercise was 10.5 +/- 1.9 min in patients and 13.4 +/- 2 min in control subjects (p = 0.0001). Overall, patients reached 73% of peak oxygen uptake achieved by control subjects (32.6 +/- 5.6 vs 44.7 +/- 6 mL/kg/min). Chronotropic response (188 +/- 15.7 vs 166.5 +/- 19.6 beats/min [p = 0.0001]) and oxygen pulse (7.4 +/- 2.9 vs 10.7 +/- 4.2 mL/beat [p = 0.0002]) were lower in patients at peak exercise. Patients had a greater respiratory response to exercise: both respiratory rate and ventilatory equivalent for carbon dioxide were significantly higher at all stages of exercise. Exercise capacity assessed by peak oxygen uptake was correlated with time elapsed since surgical repair (r = 0.48; p = 0.001).
It is concluded that even in asymptomatic patients, exercise endurance and respiratory response are generally altered as much as 11 +/- 2.8 years after venous switch operation, although early surgical repair is predictive of a better long-term functional result.
本研究报告了大动脉转位患者行静脉调转术后对分级运动的心肺反应。
几项小型研究记录了Mustard法修复大动脉转位术后运动耐量降低，但关于接受Senning手术患者的长期心肺运动表现的信息却很少。
这项前瞻性研究报告了43例（年龄12±3.1岁）接受Senning手术且术后无明显异常的患者的系列长期（平均11±2.8年）心肺运动表现。还研究了43名匹配的健康儿童作为对照组。
所有人均接受运动测试（Bruce方案）及代谢气体交换，以确定3分钟时的参数、无氧阈值、相似心率（150次/分钟）和运动峰值。患者的运动时间为10.5±1.9分钟，对照组为13.4±2分钟（p = 0.0001）。总体而言，患者达到的峰值摄氧量为对照组的73%（32.6±5.6 vs 44.7±6毫升/千克/分钟）。患者在运动峰值时的变时反应（188±15.7 vs 166.5±19.6次/分钟 [p = 0.0001]）和氧脉搏（7.4±2.9 vs 10.7±4.2毫升/次 [p = 0.0002]）较低。患者对运动的呼吸反应更大：在运动的所有阶段，呼吸频率和二氧化碳通气当量均显著更高。通过峰值摄氧量评估的运动能力与手术修复后的时间相关（r = 0.48；p = 0.001）。
得出的结论是，即使是无症状患者，在静脉调转术后11±2.8年，运动耐力和呼吸反应通常也会发生改变，尽管早期手术修复预示着更好的长期功能结果
