Traversi E, Pozzoli M, Grande A, Forni G, Assandri J, Viganò M, Tavazzi L
Department of Cardiology, Montescano Medical Center, Salvatore Maugeri Foundation, Pavia, Italy.
J Heart Lung Transplant. 1998 Nov;17(11):1065-74.
Atrial function is an important determinant of cardiac performance. In patients who undergo operation by standard heart transplantation atrial enlargement, distortion of geometry and asynchronous contraction resulting from the donor/recipient atrial connections may affect atrial function. The bicaval anastomosis technique should be free from these limitations.
We used the echocardiographic automatic boundary detection technique to obtain on-line time/volume curves of right and left atria from patients who had undergone bicaval (n = 22) or standard (n = 27) heart transplantation and from 15 control subjects. Maximal, middiastolic, preatrial contraction, and minimal volumes of both atria were measured. Reservoir volume (defined as the difference between maximal and middiastolic atrial volumes); pump volume (defined as the difference between preatrial contraction and minimal atrial volumes); and conduit volume (defined as the difference between left ventricular stroke volume and the sum of reservoir and pump volumes) were derived for both atria. Atrial emptying fraction was calculated as the difference between maximal and minimal volumes divided by the maximal volume and expressed in percent and pump fraction as the pump volume divided by the sum of reservoir and pump volumes. Tricuspid and mitral regurgitation, evaluated by color-flow Doppler scanning, were considered significant when they were greater than grade 1. Atrial ejection force was calculated from mitral and tricuspid flow velocities at atrial contraction.
In patients who had bicaval heart transplantation, both atria were smaller than in patients who underwent standard heart transplantation. With the bicaval technique right and left atrial emptying (right 45% +/- 9% vs 36% +/- 10%, p < .05; left 51% +/- 8% vs 39% +/- 8%, p < .001) and pump fractions (right 57% +/- 17% vs 19% +/- 13%, p < .001; left 45% +/- 28% vs 22% +/- 12%, p < .01) were greater than with the standard technique and similar to those in control subjects. Right atrial ejection force was significantly greater in bicaval (10.0 +/- 5.6 kdyne) than in standard heart transplantation (4.5 +/- 2.2 kdyne, p < .0001). Significant tricuspid or mitral regurgitation was rarely found in bicaval heart transplant recipients (3 and 1 of the 22 patients, respectively), although they were much more frequent after standard heart transplantation (13 and 8 of the 27 patients, respectively).
Heart transplantation performed with the bicaval anastomosis technique determines smaller atrial volumes, yields better right and left atrial function and fewer atrioventricular valve regurgitation than the standard technique.
心房功能是心脏功能的重要决定因素。在接受标准心脏移植手术的患者中，供体/受体心房连接导致的心房扩大、几何形状扭曲和异步收缩可能会影响心房功能。双腔静脉吻合技术应无这些局限性。
我们使用超声心动图自动边界检测技术，从接受双腔静脉（n = 22）或标准（n = 27）心脏移植的患者以及15名对照受试者中获取左右心房的在线时间/容积曲线。测量了两个心房的最大、舒张中期、心房收缩前和最小容积。计算了两个心房的储备容积（定义为最大和舒张中期心房容积之差）；泵血容积（定义为心房收缩前和最小心房容积之差）；以及管道容积（定义为左心室每搏量与储备容积和泵血容积之和的差值）。心房排空分数计算为最大和最小容积之差除以最大容积，以百分比表示，泵血分数为泵血容积除以储备容积和泵血容积之和。通过彩色多普勒扫描评估的三尖瓣和二尖瓣反流，当大于1级时被认为是显著的。心房射血力根据心房收缩时二尖瓣和三尖瓣的流速计算得出。
在接受双腔静脉心脏移植的患者中，两个心房均比接受标准心脏移植的患者小。采用双腔静脉技术时，左右心房的排空（右心房45%±9%对36%±10%，p <.05；左心房51%±8%对39%±8%，p <.001）和泵血分数（右心房57%±17%对19%±13%，p <.001；左心房45%±28%对22%±12%，p <.01）均高于标准技术，且与对照受试者相似。双腔静脉心脏移植患者的右心房射血力（10.0±5.6达因）明显高于标准心脏移植患者（4.5±2.2达因，p <.0001）。双腔静脉心脏移植受者很少发现显著的三尖瓣或二尖瓣反流（分别为22例患者中的3例和1例），尽管在标准心脏移植后更为常见（分别为27例患者中的13例和8例）。
与标准技术相比，采用双腔静脉吻合技术进行心脏移植可使心房容积更小，左右心房功能更好，房室瓣反流更少。
