Heart:Fontan循环中使用开窗术作为慢性心脏保护的策略

2019-03-14 xiangting MedSci原创

与NC-F患者相比,P-F患者具有稳健的血流动力学,并且前负荷储备安全、后负荷减少、β-肾上腺素能反应抑制以及基线HR较低。

Fontan循环的开窗术通过减弱静脉充血的稳定血流动力学,使患者摆脱导致心血管重塑的因素。这项研究假设开窗Fontan手术除了保留前负荷外,还具有慢性血流动力学优势。

研究招募了35名开窗Fontan患者,这些患者多巴酚丁胺(DOB)输注和/或瞬时开窗闭塞(TFO)时具有构建的压力-容积关系。尽管使用了抗血小板药和抗凝剂,11名患者证实有开窗的自然闭合。将开窗未闭(P-F)患者的心血管特征与开窗自然闭合(NC-F)患者进行比较。为进一步描述开窗术的作用,对P-F患者在DOB或快速心房起搏伴/不伴TFO的情况下进行配对分析。

与P-F相比,NC-F患者的心率(HR)较快、心室舒张末期面积较小、射血分数较好、中心静脉压及肺阻力较高。虽然DOB输注后观察到类似结果,但与P-F患者相比,DOB显著增加NC-F患者的舒张期和收缩期心室僵硬度。作为P-F和NC-F患者间关系的镜像,TFO显著降低前负荷、抑制心输出量并增加后负荷和舒张僵硬度。重要的是,快速心房起搏破坏了开窗术的这些血液动力学优势。

尽管优势被HR升高所掩盖或恶化,但与NC-F患者相比,P-F患者具有稳健的血流动力学,并且前负荷储备安全、后负荷减少、β-肾上腺素能反应抑制以及基线HR较低。

原始出处:

Hirofumi Saiki. Fenestration in the Fontan circulation as a strategy for chronic cardioprotection. Heart. 02 March 2019.

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    2019-03-16 zhaojie88
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    2019-03-16 slcumt