The left ventricular performance in patients with pulmonary atresia with intac t ventricular septum who were Fontan candidates before and after the bidirection al Glenn procedure and a staged total cavopulmonary conne...The left ventricular performance in patients with pulmonary atresia with intac t ventricular septum who were Fontan candidates before and after the bidirection al Glenn procedure and a staged total cavopulmonary connection was compared with that in patients with tricuspid atresia. Contractility(end-systolic elastance) , afterload(effective arterial elastance), and ventricular efficiency(ventriculo arte-rial coupling, arterial elastance/end-systolic elastance ratio), and the ratio of stroke work and pressure-volume area were approximated on the basis of cardiac catheterization data before the bidirectional Glenn procedure, before and after staged total cavopulmonary connection, and approxi mately 1 year after the completion of total cavopulmonary connection in 20 patie nts with pulmonary atresia with intact ventricular septum and 21 patients with t ricuspid atresia. The end-systolic elastance of the pulmonary atresia with inta ct ventricular septum group was significantly inferior to that of the tricuspid atresia group after bidirectional Glenn procedure and total cavopulmonary connec tion(1 year after total cavopulmonary connection 1.85 0.51 mm Hg m2 mL-1 vs 2.8 4 0.96 mm Hg m2 mL-1, P . 01). The arterial elastance was not different between groups throughout the assessment period and tended to increase in a stepwise fa shion after bidirectional Glenn procedure and total cavopulmonary connection. Th e arterial elastance/end-systolic elastance ratio and ratio of stroke work and pressure-volume area of the pulmonary atresia with intact ventricular septum gr oup tended toworsen,whereas those of the tricuspid atresia group tended to impro ve. The difference reached statistical significance 1 year after total cavopulmo nary connection(1.15 0.35 vs 0.82 0.23 and 64.2%6.7%vs 71.3%5.7%, respective ly, P . 05 and P . 05, respectively). The contractility and ventricular efficien cy of patients with pulmonary atresia with intact ventricular septum are inferio r to those of patients with tricuspid atresia after bidirectional Glenn procedur e and total cavopulmonary connection. A high-pressure residual right ventricle may impair the left ventricular performance of patients with pulmonary atresia w ith intact ventricular septum after bidirectional Glenn procedure and total cavo pulmonary connection.展开更多
文摘The left ventricular performance in patients with pulmonary atresia with intac t ventricular septum who were Fontan candidates before and after the bidirection al Glenn procedure and a staged total cavopulmonary connection was compared with that in patients with tricuspid atresia. Contractility(end-systolic elastance) , afterload(effective arterial elastance), and ventricular efficiency(ventriculo arte-rial coupling, arterial elastance/end-systolic elastance ratio), and the ratio of stroke work and pressure-volume area were approximated on the basis of cardiac catheterization data before the bidirectional Glenn procedure, before and after staged total cavopulmonary connection, and approxi mately 1 year after the completion of total cavopulmonary connection in 20 patie nts with pulmonary atresia with intact ventricular septum and 21 patients with t ricuspid atresia. The end-systolic elastance of the pulmonary atresia with inta ct ventricular septum group was significantly inferior to that of the tricuspid atresia group after bidirectional Glenn procedure and total cavopulmonary connec tion(1 year after total cavopulmonary connection 1.85 0.51 mm Hg m2 mL-1 vs 2.8 4 0.96 mm Hg m2 mL-1, P . 01). The arterial elastance was not different between groups throughout the assessment period and tended to increase in a stepwise fa shion after bidirectional Glenn procedure and total cavopulmonary connection. Th e arterial elastance/end-systolic elastance ratio and ratio of stroke work and pressure-volume area of the pulmonary atresia with intact ventricular septum gr oup tended toworsen,whereas those of the tricuspid atresia group tended to impro ve. The difference reached statistical significance 1 year after total cavopulmo nary connection(1.15 0.35 vs 0.82 0.23 and 64.2%6.7%vs 71.3%5.7%, respective ly, P . 05 and P . 05, respectively). The contractility and ventricular efficien cy of patients with pulmonary atresia with intact ventricular septum are inferio r to those of patients with tricuspid atresia after bidirectional Glenn procedur e and total cavopulmonary connection. A high-pressure residual right ventricle may impair the left ventricular performance of patients with pulmonary atresia w ith intact ventricular septum after bidirectional Glenn procedure and total cavo pulmonary connection.
