Zakaria M
Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Hokkaido Igaku Zasshi. 1997 Nov;72(6):607-19.
Pulmonary hypertensive patients have been found to have greater morbidity and mortality from isolated ventricular septal defect closure than those pulmonary non-hypertensive patients. In this study, the author evaluated the relation between pulmonary artery muscularity and pulmonary artery pressure and resistance and compared the haemodynamic effects between normal and raised pulmonary artery pressure groups in isolated ventricular septal defect. The patients were divided into two groups, group-I (n = 14): pulmonary artery pressure of 50 mmHg or less than 50 mmHg, and group-II (n = 6): pulmonary artery pressure more than 50 mmHg. The group-II patients were further studied during cardiac catheterization by inhaling 100% oxygen for 15 minutes to detect any fall in pulmonary artery pressure. The patients whose pulmonary artery pressure did not drop were considered to have operative intervention after lung biopsy. The mean pulmonary artery pressure, right ventricular pressure and pulmonary vascular resistance in group-I and group-II were 26.9 +/- 7.0 mmHg, 44.0 +/- 2.5 mmHg, 2.2 +/- 0.6 units/m2 vs 84.2 +/- 20.7 mmHg, 100.5 +/- 7.0 mmHg, 10.0 +/- 0.9 units/m2, respectively (p < 0.001). The left to right shunt flow in group-I and group-II was 50.6 +/- 6.0% vs 44.0 +/- 8.6%, respectively and was not significantly different (p < 0.1). In the operated group (n = 17), pulmonary artery pressures ranged 20-110 mmHg, size of the VSD 7.5-11.5 mm, and pulmonary vascular resistance 1.7-8.2 units/m2. In isolated ventricular septal defect, when the pulmonary vascular change was reversible, there was a positive correlation both between the VSD size and the level of pulmonary arterial pressure (r = 0.94, p < 0.001) and between the pulmonary arterial pressure and pulmonary vascular resistance (r = 0.95, p < 0.001). Lung biopsy (n = 9) showed grade I Heath-Edward change in 6 cases (66.6%), grade II change in 1 case (11.1%), and grade III in 2 cases (22.2%). From these findings, when pulmonary vascular resistance is 8 units/m2 or more, operative indication should be determined on the basis of lung biopsy. Not only the gradings of pulmonary vascular changes, but the extent of vascular involvement and the duration of the lung exposure to the shunt anomally also need to be considered before surgery.
已发现肺动脉高压患者与肺动脉非高压患者相比，因孤立性室间隔缺损封堵术导致的发病率和死亡率更高。在本研究中，作者评估了肺动脉肌层厚度与肺动脉压力和阻力之间的关系，并比较了孤立性室间隔缺损患者中正常肺动脉压力组和升高肺动脉压力组之间的血流动力学效应。患者被分为两组，第一组（n = 14）：肺动脉压力为50 mmHg或低于50 mmHg；第二组（n = 6）：肺动脉压力高于50 mmHg。对第二组患者在心脏导管检查期间进一步进行研究，通过吸入100%氧气15分钟以检测肺动脉压力是否下降。肺动脉压力未下降的患者在肺活检后被认为需要进行手术干预。第一组和第二组的平均肺动脉压力、右心室压力和肺血管阻力分别为26.9±7.0 mmHg、44.0±2.5 mmHg、2.2±0.6单位/m²与84.2±20.7 mmHg、100.5±7.0 mmHg、10.0±0.9单位/m²（p < 0.001）。第一组和第二组的左向右分流率分别为50.6±6.0%和44.0±8.6%，差异无统计学意义（p < 0.1）。在手术组（n = 17）中，肺动脉压力范围为20 - 110 mmHg，室间隔缺损大小为7.5 - 11.5 mm，肺血管阻力为1.7 - 8.2单位/m²。在孤立性室间隔缺损中，当肺血管变化可逆时，室间隔缺损大小与肺动脉压力水平之间（r = 0.94，p < 0.001）以及肺动脉压力与肺血管阻力之间（r = 0.95，p < 0.001）均呈正相关。肺活检（n = 9）显示6例（66.6%）为I级希思 - 爱德华改变，1例（11.1%）为II级改变，2例（22.2%）为III级改变。根据这些发现，当肺血管阻力为8单位/m²或更高时，应根据肺活检确定手术指征。在手术前，不仅需要考虑肺血管变化的分级，还需要考虑血管受累程度以及肺暴露于分流异常的持续时间。
