手术前体积过载对左心室功能恢复的影响,心室隔膜缺陷修复后的功能恢复
Raya Safa1, Ashley Dean2, Yamuna Sanil3
1Department of Pediatrics, Division of Cardiology, Central Michigan University, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Critical Care, Central Michigan University, Children's Hospital of Michigan, Detroit, Michigan.
The American journal of cardiology
|July 29, 2023
概括
在患有心室隔膜缺陷 (VSD) 的患者中,手术前的左心室扩张与VSD修复后的暂时早期缩功能障碍有关. 然而,左心室功能在一年内完全恢复,提供了积极的预后.
科学领域:
- 心脏病学 心脏病学
- 儿童心脏病学 儿童心脏病学
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
背景情况:
- 心室隔膜缺陷 (VSD) 可以导致左心室 (LV) 体积过载和扩张.
- 在VSD修复后,急性失去LV预负载可能会损害LV缩功能.
研究的目的:
- 为了确定手术前 LV 扩张是否会影响 VSD 修复后的 LV 缩功能恢复.
- 在手术后的不同时间点评估LV纵向应变和射出分数 (EF).
主要方法:
- 在120名VSD患者中对LV系统功能 (EF和纵向菌株) 的心声评估.
- 术前 LV 扩张 (n=84) 与正常 LV 大小 (n=36) 的患者的比较.
- 从手术前到VSD修复后12个月以上的连续评估.
主要成果:
- 手术前 LV 扩张的患者在早期术后期 (0-6 周) 显著降低了 LV EF 和应变.
- 修复后2-6周,LV喷射分数正常化,而扩张组的应变率在4个月后仍然较低.
- 在VSD修复4个月后,没有观察到群体之间的LV EF或菌株的显著差异.
结论:
- 手术前的LV扩张与VSD修复后的过渡性,早期的手术后的LV缩功能障碍有关.
- LV 缩功能显示显著恢复,在修复后的第一年内恢复到基线水平.
- 这些发现为接受VSD修复的患者提供了令人放心的预后,无论手术前的LV大小如何.
相关概念视频
Regulation of Stroke Volume
3.3K
The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
3.3K
Mitral Stenosis I: Introduction
16
Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
16
Cardiomyopathy VII: Pre and Post Operative Nursing Management
16
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
16
Cardiac Output II: Effect of Stroke Volume on Cardiac Output
1.1K
Cardiac output (CO), the amount of blood the heart pumps per minute, is a parameter in cardiovascular physiology determined by stroke volume and heart rate. Stroke volume, the amount of blood pushed from one of the ventricles per heartbeat, is influenced by preload, afterload, and contractility.
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
1.1K
Heart Failure II: Pathophysiology
15
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
15


