Fogel M A, Rychik J, Vetter J, Donofrio M T, Jacobs M
Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, 19104, USA.
J Thorac Cardiovasc Surg. 1997 Apr;113(4):718-26; discussion 726-7. doi: 10.1016/S0022-5223(97)70229-0.
The objectives of this study were to define physiologic effects on and a clinical correlate to coronary blood flow during volume unloading surgery in patients with aortic atresia.
Twenty-two patients with aortic atresia (group I, 13 patients with stage I reconstruction undergoing hemi-Fontan operation; group II, 9 patients with hemi-Fontan undergoing Fontan operation) underwent perioperative transesophageal echocardiography. Doppler spectral patterns, peak velocity, velocity time integral, and blood flow in the native ascending aorta were measured. Preoperative hemodynamics and postoperative clinical data were analyzed. Significance was defined as p < 0.05.
Higher values of coronary blood flow (982.9 +/- 321.7 vs 548.6 +/- 333.8 ml/min per square meter), velocity time integral (20.7 +/- 5.6 vs 12.6 +/- 4.0 cm), and peak velocity (96.1 +/- 21.4 vs 51.0 +/- 18.2 cm/sec) were found before operation in group I than after operation and in group II at both times. Flow changed from predominately systolic in preoperative group I to both systolic and diastolic after operation and in group II. Before operation in groups I and II, a number of hemodynamic parameters such as superior vena cava oxygen saturation correlated with coronary blood flow dynamics. After operation in group II, urine output (r = 0.86) and central venous pressure (r = -0.85) correlated with coronary blood flow dynamics.
Coronary blood flow parameters were higher in group I as a result of the increased energy needs required to pump to two circulations. No changes were found in group II. A number of coronary blood flow parameters correlated with preoperative hemodynamics and postoperative clinical data. These parameters appear to be useful in assessing the performance status of the myocardium after the Fontan operation, consistent with the notion that myocardial perfusion relates directly to ventricular function.
本研究的目的是确定主动脉闭锁患者在容量卸载手术期间对冠状动脉血流的生理影响及其临床关联。
22例主动脉闭锁患者（I组，13例接受半Fontan手术的I期重建患者；II组，9例接受Fontan手术的半Fontan患者）接受围手术期经食管超声心动图检查。测量了升主动脉的多普勒频谱模式、峰值速度、速度时间积分和血流。分析术前血流动力学和术后临床数据。显著性定义为p<0.05。
I组术前的冠状动脉血流值（982.9±321.7 vs 548.6±333.8 ml/min每平方米）、速度时间积分（20.7±5.6 vs 12.6±4.0 cm）和峰值速度（96.1±21.4 vs 51.0±18.2 cm/秒）高于术后及II组的两个时间点。I组术前血流以收缩期为主，术后及II组变为收缩期和舒张期。I组和II组术前，一些血流动力学参数如腔静脉血氧饱和度与冠状动脉血流动力学相关。II组术后，尿量（r = 0.86）和中心静脉压（r = -0.85）与冠状动脉血流动力学相关。
由于向两个循环泵血所需的能量需求增加，I组的冠状动脉血流参数较高。II组未发现变化。一些冠状动脉血流参数与术前血流动力学和术后临床数据相关。这些参数似乎有助于评估Fontan手术后心肌的功能状态，这与心肌灌注直接关系到心室功能的观点一致。
