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首页> 外文期刊>The American Journal of Cardiology >Comparison of Outcomes in Adults With Ventricular Septal Defect Closed Earlier in Life Versus Those in Whom the Defect Was Never Closed
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Comparison of Outcomes in Adults With Ventricular Septal Defect Closed Earlier in Life Versus Those in Whom the Defect Was Never Closed

机译：生活中患有心室间隔缺陷的成年人的结果比较与那些从未关闭过缺陷的人

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Ventricular septal defects (VSDs) have recently demonstrated poorer functional outcome with disrupted ventricular contractility during exercise in young patients. It is not known whether this will change with age. Therefore, echocardiography was performed in older patients with congenital VSDs, either surgically closed or unrepaired and all without Eisenmenger physiology, to compare functional outcomes with healthy peers. Transthoracic echocardiography was performed at rest and during supine bicycle exercise, with tissue velocity Doppler for assessment of primary end points: isovolumetric acceleration and systolic velocities. In total, 30 surgically closed VSDs (51 +/- 8 years) with 30 healthy controls (52 +/- 9 years) and 30 unrepaired VSDs (55 +/- 12 years) with 30 matched controls (55 +/- 10 years) were included. Surgical patients displayed lower right ventricular (RV) systolic and early diastolic-filling velocities compared with controls, p <0.01, lower tricuspid annular plane systolic excursion (17.8 +/- 5 vs 22.7 +/- 3mm, p <0.01) and lower fractional area change (37.8 +/- 6 vs 46.4% +/- 7%, p <0.01). Unrepaired VSDs also had lower RV fractional area change than matched controls (39.9 +/- 7 vs 48.4% +/- 7%, p <0.01). Both patient groups had more tricuspid regurgitation and larger RV outflow tract dimensions than controls, p <0.01. During exercise, isovolumetric acceleration and systolic velocities were lower in both patient groups compared with controls, with the difference increasing with workload level. In conclusion, adults in their mid-50s with surgically closed or unrepaired VSDs have abnormal RV function at rest, with even more pronounced differences during exercise. These results suggest that a VSD, whether repaired early or considered hemodynamically insignificant, is not a benign lesion and continuous follow-up of adults is warranted. (c) 2020 Elsevier Inc. All rights reserved.
机译：最近，室间隔缺损（VSD）在年轻患者的运动中表现出功能较差，心室收缩力受损。目前还不知道这是否会随着年龄的增长而改变。因此，对老年先天性室间隔缺损患者进行超声心动图检查，无论是手术关闭的还是未修复的，都没有艾森曼格生理学，以比较功能结果与健康同龄人。在休息和仰卧自行车运动期间进行经胸超声心动图检查，用组织速度多普勒评估主要终点：等容加速度和收缩速度。总共包括30例手术闭合的室间隔缺损（51+/-8年），30例健康对照组（52+/-9年），30例未修复的室间隔缺损（55+/-12年），30例匹配对照组（55+/-10年）。与对照组相比，手术患者显示右心室（RV）收缩和舒张早期充盈速度较低，p<0.01，三尖瓣环平面收缩偏移较低（17.8+/-5 vs 22.7+/-3mm，p<0.01），面积分数变化较低（37.8+/-6 vs 46.4%+/-7%，p<0.01）。与匹配的对照组相比，未修复的VSD的RV部分面积变化也较低（39.9+/-7 vs 48.4%+/-7%，p<0.01）。两组患者的三尖瓣返流和RV流出道尺寸均大于对照组，p<0.01。在运动过程中，两组患者的等容加速度和收缩速度均低于对照组，差异随着工作负荷水平的增加而增加。综上所述，50多岁左右患有手术闭合或未修复室间隔缺损的成年人在休息时RV功能异常，在运动期间差异更为显著。这些结果表明，室间隔缺损，无论是早期修复还是认为血流动力学不重要，都不是良性病变，需要对成人进行持续随访。（c） 2020爱思唯尔公司版权所有。

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