Abnormal cardiac autonomic nervous activity after right ventricular outflow tract reconstruction

Article

关键词: HEART-RATE RESPONSE;    PARASYMPATHETIC CONTROL;    FONTAN OPERATION;    EXERCISE;    TRANSPLANTATION;    REINNERVATION;    FAILURE;    DISEASE;    TETRALOGY;    MECHANISM;   

DOI  :  10.1161/01.CIR.102.22.2732

来源: SCIE

【 摘 要 】

Background-There are few studies of cardiac autonomic nervous activity (CANA) in patients with congenital heart disease. Methods and Results-We evaluated CANA in 54 patients after closure of an atrial/ventricular septal defect (group A), 54 patients after successful right ventricular outflow tract reconstruction (RVOTR) (group B1), 35 RVOTR patients with residual stenosis (group B2), and 47 controls. Cardiac parasympathetic nervous activity (PSNA) was estimated by heart rate (HR) change after cholinergic blockade, HR variability, and arterial baroreflex sensitivity (BRS). Cardiac sympathetic nervous activity was estimated by the heart-to-mediastinum I-123-metaiodobenzylguanidine activity ratio (H/M) and HR increase after isoproterenol infusion (beta). HR response (Delta HR) and peak oxygen uptake ((V) over dot o(2)) were measured by exercise test. There was no difference in beta among study groups. Group A exhibited mildly impaired PSNA, which recovered 1 year after surgery, and no change in H/M. Impaired PSNA and low H/M were found in groups BI and B2 compared with controls (P<0.001), although the PSNA tended to recover 1 year after re-RVOTR. In group BI, PSNA and were related to Delta HR, and BRS correlated inversely with the number of surgical procedures and age at RVOTR and positively correlated with the follow-up period, whereas Delta HR correlated with peak (V) over dot o(2) (P<0.01 to 0.001). Conclusions-After RVOTR, postsynaptic -sensitivity is maintained and is important in Delta HR during exercise, as is PSNA, although ventricular sympathetic denervation is common. Impaired PSNA immediately after RVOTR improves with improved Delta HR and results in future amelioration of aerobic capacity, whereas ventricular sympathetic reinnervation is uncertain.

【 授权许可】

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