HEMODYNAMIC ABNORMALITIES IN RESPONSE TO MILD AND INTENSE UPRIGHT EXERCISE FOLLOWING OPERATIVE CORRECTION OF AN ATRIAL SEPTAL-DEFECT OR TETRALOGY OF FALLOT
HEMODYNAMIC ABNORMALITIES IN RESPONSE TO MILD AND INTENSE UPRIGHT EXERCISE FOLLOWING OPERATIVE CORRECTION OF AN ATRIAL SEPTAL-DEFECT OR TETRALOGY OF FALLOT
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DOI：
10.1161/01.cir.47.5.1065
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发表时间：
1973-01-01
期刊：
影响因子：
37.8
通讯作者：
MORROW, AG
中科院分区：
文献类型：
--
作者：
EPSTEIN, SE;BEISER, GD;MORROW, AG
房间隔缺损 (ASD) 或法洛四联症 (TF) 手术矫正后，患者通常无症状。然而，他们的心脏相对于正常受试者的最大功能容量尚未确定。对 12 名 ASD 闭合的无症状患者和 10 名法洛四联症完全矫正的无症状患者在休息时以及轻度和剧烈跑步机运动期间进行导管插入研究进行评估。除了法洛四联症组右心室流出梯度较小（2-21 mm Hg）外，每位受试者在静息时记录的数据均正常或接近正常。然而，在强度足以将肺动脉氧饱和度降低至 30% 的直立运动水平下，12 名 ASD 患者中的 7 名（平均 6.6 ± 0.6 升/分钟/m2）和 10 名法洛四联症患者中的 8 名（平均 6.1 ± 0.3 升/分钟/m2）心输出量低于正常受试者的水平（平均 8.9 ± 0.3 升/分钟/m2）。六名 TF 患者在直立运动期间测量的右心室 (RV) 流出梯度均有所增加；在所研究的 6 名患者中，有 4 名患者的 RV 收缩压达到 75-106 mm Hg 的水平。 ASD 组中未观察到流出梯度。因此，在没有残余分流、心律失常或肺动脉高压的情况下，手术闭合 ASD 且静息时血流动力学结果正常的患者可能会损害其对剧烈直立运动的心输出量反应。尽管矫正法洛四联症患者的心输出量反应持续降低，但考虑到其缺陷和手术修复的复杂性，这是非常好的。然而，右心室流出梯度和右心室收缩压可能会随着运动而显着增加。这些发现的长期意义仍有待确定。
Patients are often asymptomatic after operative correction of an atrial septal defect (ASD) or tetralogy of Fallot (TF). However, the maximal functional capacity of their hearts relative to that of normal subjects has not been defined. Twelve asymptomatic patients who had ASDs closed and 10 asymptomatic patients who had total correction of tetralogy of Fallot were evaluated by catheterization studies at rest and during mild and intense treadmill exercise. Except for small right ventricular outflow gradients in the tetralogy of Fallot group (2-21 mm Hg), data recorded at rest were normal or nearly so in each subject. However, at a level of upright exercise sufficiently intense to lower pulmonary arterial oxygen saturation to 30%, cardiac output was below that attained by normal subjects (mean, 8.9 ± 0.3 liters/min/m2) in seven of 12 ASD patients (mean, 6.6 ± 0.6 liters/min/m2) and in eight of 10 tetralogy of Fallot patients (mean, 6.1 ± 0.3 liters/min/m2). Right ventricular (RV) outflow gradients, measured during upright exercise in six TF patients, increased in each; RV systolic pressures reached levels of 75-106 mm Hg in four of the six patients studied. No outflow gradients were observed in the ASD group. Thus, patients with operative closure of an ASD and normal hemodynamic findings at rest may have impairment of their cardiac output response to intense upright exercise in the absence of residual shunts, arrhythmias, or pulmonary arterial hypertension. Although the cardiac output response in patients with corrected tetralogy of Fallot is consistently reduced, it is remarkably good considering the complicated nature of their defect and operative repair; however, the RV outflow gradient and RV systolic pressure may increase markedly with exercise. The longterm significance of these findings remains to be determined.