Xie G Y, Lin C S, Preston H M, Taylor C G, Kearney K, Sapin P M, Smith M D
Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington 40536, USA.
Chest. 1998 Aug;114(2):477-81. doi: 10.1378/chest.114.2.477.
This study was designed to observe left ventricular filling by Doppler echocardiography before and after single lung transplantation in patients with severe pulmonary hypertension.
Right ventricular pressure overload causes the deformation of the left ventricle by septal flattening toward its cavity, which may result in impaired left ventricular early filling. Recent studies have demonstrated the ability of single lung transplantation to restore right ventricular function in patients with severe pulmonary hypertension. However, changes in left ventricular filling after single lung transplantation have not been well studied.
We performed Doppler echocardiography in nine patients with severe pulmonary hypertension before, early (<3 months), and late (>1 year) after single lung transplantation. The study group consisted of eight female patients and one male patient with mean age of 32 years (range, 15 to 48 years). Six patients were diagnosed as having primary pulmonary hypertension and three as having secondary pulmonary hypertension. Nine age-matched normal subjects served as a control group. Doppler measurements included the following: transmitral flow early (E) and atrial (A) velocities, integrals (Ei and Ai), and left ventricular isovolumic relaxation time. The ratio of E/A and atrial filling fraction (Ai/Ei+Ai, AFF) were also determined. Left ventricular geometry was assessed from mid-short axis view with a circular shape factor (CSF).
Early after lung transplantation, the left ventricular geometry became more circular with CSF (mean+/-SD) increasing from 0.63+/-0.09 to 0.88+/-0.05 (p<0.05). However, impaired early filling persisted in the patient group (E/A 0.7+/-0.1 vs preoperative 0.6+/-0.1, AFF 0.61+/-0.1 vs 0.64+/-0.1; both p=not significant). One year later, the left ventricular filling had returned to normal range with E/A 1.4+/-0.6 and AFF 0.35+/-0.1.
This study observed that the impaired left ventricular early filling persisted shortly after single lung transplantation in patients with severe pulmonary hypertension, despite findings that left ventricular geometry was restored earlier after reversal of pulmonary hypertension. The abnormal filling pattern appeared to be resolved 1 year later. The findings suggest the impaired early filling may be caused by intrinsic left ventricular abnormalities other than ventricular interaction in these patients.
本研究旨在通过多普勒超声心动图观察重度肺动脉高压患者单肺移植前后的左心室充盈情况。
右心室压力超负荷会导致室间隔向心腔扁平变形，进而引起左心室变形，这可能会导致左心室早期充盈受损。近期研究表明，单肺移植能够恢复重度肺动脉高压患者的右心室功能。然而，单肺移植后左心室充盈的变化尚未得到充分研究。
我们对9例重度肺动脉高压患者在单肺移植前、移植早期（<3个月）和晚期（>1年）进行了多普勒超声心动图检查。研究组包括8例女性患者和1例男性患者，平均年龄32岁（范围15至48岁）。6例患者被诊断为原发性肺动脉高压，3例为继发性肺动脉高压。9例年龄匹配的正常受试者作为对照组。多普勒测量包括以下内容：二尖瓣血流早期（E）和心房（A）速度、积分（Ei和Ai）以及左心室等容舒张时间。还测定了E/A比值和心房充盈分数（Ai/Ei+Ai，AFF）。从短轴中段视图评估左心室几何形状，采用圆形形状因子（CSF）。
肺移植后早期，左心室几何形状变得更接近圆形，CSF（平均值±标准差）从0.63±0.09增加到0.88±0.05（p<0.05）。然而，患者组早期充盈受损仍持续存在（E/A为0.7±0.1，术前为0.6±0.1；AFF为0.61±0.1，术前为0.64±0.1；两者p均无统计学意义）。1年后，左心室充盈恢复到正常范围，E/A为1.4±0.6，AFF为0.35±0.1。
本研究观察到，重度肺动脉高压患者单肺移植后不久，尽管肺动脉高压逆转后左心室几何形状较早恢复，但左心室早期充盈受损仍持续存在。异常充盈模式似乎在1年后得到解决。这些发现表明，早期充盈受损可能是由这些患者左心室内在异常而非心室相互作用引起的。
