Right ventricular function in adult atrial septal defect. Preoperative and postoperative assessment and clinical implications.
Right ventricular function in adult atrial septal defect. Preoperative and postoperative assessment and clinical implications.
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成人房间隔缺损的右心室功能。
DOI：
10.1016/0002-9149(81)90289-7
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
Pohost,GM
中科院分区：
文献类型：
--
作者：
Liberthson,RR;Boucher,CA;Strauss,HW;Dinsmore,RE;McKusick,KA;Pohost,GM
应用门控心血池扫描技术对20例成人房间隔缺损患者的右心功能进行了评价。所有患者在手术修复前和手术修复后6个月或更长时间内都进行了扫描。临床表现、术前和术后病程以及心导管检查数据与扫描结果相关。在所有20例患者中，术前右心室扩张。9例患者（年龄18 ~ 42岁，平均25岁）术前右室壁运动正常。所有9人均无症状，窦性心律正常。他们的肺与体循环血流比范围在2：1和5：1之间，肺动脉收缩压在18和30 mm Hg之间，右心室舒张末期压在0和8 mm Hg之间。9例房间隔缺损修补术后均无症状，右室大小明显缩小，室壁运动正常，其余11例（年龄36 ~ 63岁，平均52岁）术前有中度至重度右室运动功能减退。所有患者均有术前症状（功能II级和III级，纽约心脏协会）; 6例房颤，5例正常窦性心律; 7例临床心力衰竭。肺与体循环血流比范围为1.7：1至5.0：1，肺动脉压范围为26至70 mm Hg，右心室舒张末期压范围为4至16 mm Hg。11例患者术后症状减轻，右心室大小和功能改善。与术前右室壁运动正常的患者不同，11例患者中只有1例术后右室功能正常且无症状。
Right ventricular function was assessed with gated cardiac blood pool scanning in 20 adult patients with an atrlal septal defect. All patients had scans both before and 6 or more months after surgical repair of the defect. Clinical findings, pre- and postoperative course and cardiac catheterization data were correlated with scan findings. In all 20 patients, the right ventricle was dilated preoperatively. In nine patients (aged 18 to 42 years, mean 25), right ventricular wall motion was normal preoperatively. All nine were asymptomatic and had normal sinus rhythm. Their pulmonary to systemic flow ratio ranged between 2:1 and 5:1, pulmonary arterial systolic pressure between 18 and 30 mm Hg and right ventricular end-diastolic pressure between 0 and 8 mm Hg. After repair of the atrlal septal defect, all nine remained asymptomatic, right ventricular size decreased dramatically and wall motion was normal.In the remaining 11 patients (aged 36 to 63 years, mean 52), there was moderate to severe preoperatlve right ventricular hypokinesia. All had preoperatlve symptoms (functional class II and III, New York Heart Association); six had atrial fibrillation and five had normal sinus rhythm; seven had clinical heart failure. Pulmonary to systemic flow ratio ranged between 1.7:1 and 5.0:1, pulmonary arterial pressure between 26 and 70 mm Hg and right ventricular end-diastolic pressure between 4 and 16 mm Hg. Symptoms were lessened and right ventricular size and function improved postoperatively in these 11 patients. Unlike those with normal preoperatlve right ventricular wall motion, however, only 1 of the 11 had normal postoperative right ventricular function and became asymptomatic.