Improved Exercise Performance in Patients With Tricuspid Atresia After the Fontan-Björk Modification With Pulsatile Systolic Pulmonary Flow

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• 作者：Masamichi Ono ; MD ; PhD^a ; ^{ono@dhm.mhn.de" class="auth_mail" title="E-mail the corresponding author} ; Manfred Vogt ; MD ; PhD^b ; Julie Cleuziou ; MD^a ; Jelena Kasnar-Samprec ; MD ; PhD^a ; Melchior Burri ; MD^a ; Martina Strbad ; MS^a ; Alfred Hager ; MD ; PhD^b ; Christian Schreiber ; MD ; PhD^a ; Jü ; rgen H&ouml ; rer ; MD ; PhD^a ; Rü ; diger Lange ; MD ; PhD^a
• 关键词：CMRI ; cardiac magnetic resonance imaging ; LVEDV ; left ventricular end-diastolic volume ; PAP ; pulmonary artery pressure ; RVEDV ; right ventricular end-diastolic volume ; RVEDVI ; right ventricular end-diastolic volume index ; RVESVI ; right ventricular end-systolic volume index ; TCPC ; total cavopulmonary connection ; VO2 ; oxygen uptake
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：101
• 期：3
• 页码：1012-1019
• 全文大小：266 K

文摘

After the Fontan-Björk modification for tricuspid atresia, some patients show pulsatile systolic pulmonary flow. We compared the hemodynamic findings and the clinical presentation of patients with and without pulsatile systolic flow after atrioventricular connection.

Methods

According to the pulmonary flow pattern by pulsed-wave Doppler assessment of transthoracic echocardiography, 41 patients after atrioventricular connection were divided into two groups: patients who showed dominant pulsatile systolic pulmonary flow (group P, n = 11), and patients who did not (group N, n = 30).

Results

Mean follow-up time was 27.8 ± 4.7 years in group P and 25.3 ± 3.8 years in group N (p = 0.1). Patients in group P had significantly less frequently catheter ablation procedures for tachyarrhythmia (9% versus 50%, p = 0.03). No patient in group P had had cardiac decompensation, whereas 7 patients (23%) in group N had had an episode of cardiac decompensation (p = 0.08). Cardiopulmonary exercise testing revealed that patients in group P showed higher oxygen uptake compared with patients in group N (25.0 ± 7.3 versus 19.6 ± 6.0 mL · kg⁻¹ · min⁻¹, p = 0.03). Patients in group P showed higher systolic pulmonary artery pressure (21.3 ± 8.4 versus 16.8 ± 4.5 mm Hg, p = 0.05), higher right ventricular end-diastolic volume index (88.6 ± 30.2 versus 50.3 ± 28.5 mL · L⁻¹ · m⁻², p = 0.03), and higher right ventricle to left ventricle ratio of end-diastolic volume index (1.4 ± 0.6 to 0.7 ± 0.3, p = 0.01).

Conclusions

Patients with pulsatile systolic flow in the pulmonary artery had better hemodynamic and better exercise performance compared with patients without pulsatile systolic flow after atrioventricular connection. A sufficient volume and function of the right ventricle is a prerequisite to create pulsatile systolic flow.