REST AND EXERCISE HEMODYNAMICS AFTER THE FONTAN PROCEDURE
REST AND EXERCISE HEMODYNAMICS AFTER THE FONTAN PROCEDURE
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DOI：
10.1161/01.cir.65.6.1043
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发表时间：
1982-01-01
期刊：
影响因子：
37.8
通讯作者：
LOCK, JE
中科院分区：
文献类型：
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作者：
BENSHACHAR, G;FUHRMAN, BP;LOCK, JE
连续16例患者（12例三尖瓣闭锁）接受Fontan手术，无手术死亡。有3例晚期死亡。11例存活者在4-25个月时选择性插管。手术后。5例患者进行了静息和运动血流动力学测量，3例仅进行了静息血流动力学测量。所有运动患者均为纽约心脏协会I级。静息时心脏指数较低（2.3 ± 0.01）。0.6 l/min/m2）和运动期间（4.9 . ±. 1.1 l/min/m2），因为静息（28 ml）和运动（35 ml）时的心搏指数均较低。因此，混合静脉氧饱和度降低（休息时为66%，运动时为31%）。这些值显著低于23名年龄和体型相似的对照患者在休息和运动时的值。心率、肺血管阻力和左心室充盈压在静息和运动时均正常。静息时高右心房压（15 mm Hg）与最小导管压差（2 mm Hg）相关。运动使平均管道压差增加到8 mm Hg，显示出显著的功能性管道阻塞。正如预期的那样，Fontan手术后对运动的心血管反应是异常的，即使在无症状的患者中也是如此。这种异常反应可能会因导管阻塞而加剧，并且导管阻塞在静息研究期间可能不明显。
Sixteen consecutive patients (12 with tricuspid atresia) underwent a Fontan procedure, with no operative deaths. There were 3 late deaths. Eleven of the survivors were electively catheterized 4-25 mo. postoperatively. Rest and exercise hemodynamics were measured in 5 patients, and resting hemodynamics alone were measured in 3. All exercised patients were New York Heart Association class I. Cardiac index was low at rest (2.3 .+-. 0.6 l/min per m2) and during exercise (4.9 .+-. 1.1 l/min per m2) due to a low stroke index both at rest (28 ml) and exercise (35 ml). Accordingly, mixed venous O2 saturations were decreased (66% at rest and 31% during exercise). These values are significantly lower than those at rest and during exercise from 23 control patients of similar age and size. Heart rates, pulmonary vascular resistance and left ventricular filling pressures appeared normal both at rest and during exercise. High right atrial pressure at rest (15 mm Hg) was associated with minimal conduit gradient (2 mm Hg). Exercise increased the mean conduit gradient to 8 mm Hg, demonstrating significant functional conduit obstruction. As expected, the cardiovascular response to exercise is abnormal after the Fontan procedure, even in asymptomatic patients. This abnormal response may be exacerbated by conduit obstruction, and conduit obstruction may not be apparent during resting studies.