Funkce systémové pravé komory po atriální korekci transpozice velkých tepen – longitudinální sledování a vliv na zátěžovou kapacitu

• Název práce v češtině: Funkce systémové pravé komory po atriální korekci transpozice velkých tepen – longitudinální sledování a vliv na zátěžovou kapacitu
• Název v anglickém jazyce: Function of systemic right ventricle after atrial correction of transposition of great arteries - longitudinal follow-up and impact on exercise capacity
• Klíčová slova: Atriální korekce transpozice velkých tepen, ejekční frakce, maximální spotřeba kyslíku, systémová pravá komora, tepová rezerva, zátěžová kapacita
• Klíčová slova anglicky: Atrial correction of transposition of great arteries, ejection fraction, maximal oxygen uptake, systenuc right ventricle, heart rate reserve, exercise capacity
• Akademický rok vypsání: 2017/2018
• Typ práce: disertační práce
• Jazyk práce: čeština
• Ústav: Klinika kardiovaskulární chirurgie (13-343)
• Vedoucí / školitel: doc. MUDr. Vilém Rohn, CSc.
• Řešitel: skrytý - zadáno a potvrzeno stud. odd.
• Datum přihlášení: 07.10.2017
• Datum zadání: 07.10.2017
• Datum potvrzení stud. oddělením: 07.10.2017
• Datum a čas obhajoby: 27.06.2022 10:00
• Datum odevzdání elektronické podoby: 13.12.2021
• Datum odevzdání tištěné podoby: 14.12.2021
• Datum proběhlé obhajoby: 27.06.2022
• Oponenti: doc. MUDr. Kateřina Linhartová, Ph.D.

Seznam odborné literatury

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Předběžná náplň práce

Maximální spotřeba kyslíku jako hlavní ukazatel zátěžové kapacity je u pacientů po atriální korekci TGA vodítkem při rozhodování o graviditě, terapeutických postupech, načasování operačních výkonů a transplantace srdce. Důsledkem atriální korekce transpozice velkých tepen je umístění pravé komory srdeční do systémové pozice. Cílem naší práce bylo zjistit, zdali ukazatele systolické funkce systémové pravé komory determinují maximální spotřebu kyslíku. V kohortě 86 pacientů po Sennigově korekci jsme stanovili třídu NYHA, hladinu NT-proBNP, provedli Holterovské a zátěžové vyšetření. Systolickou funkci pravé komory jsme hodnotili semikvantitativně echokardiograficky a kvantitatvitně prostřednictvím MR srdce. Maximální spotřeba kyslíku při zátěžovém vyšetření nekorelovala se třídou NYHA, hodnotou NT-proBNP ani ejekční frakcí systémové pravé a subpulmonální levé komory, pouze s tepovou rezervou při zátěži. Je pravděpodobné, že systolická funkce systémové pravé komory je pouze jednou ze složek mnohem složitějšího hemodynamického mechanismu, který se podílí na celkovém srdečním výdeji a jeho navýšení při zátěži.
Dalším cílem naší práce bylo zjistit dlouhodobou mortalitu všech pacientů po atriální korekci TGA a stanovit její perioperační determinanty. Zpracovali jsme perioperační údaje všech 448 nemocných operovaných touto metodou, zjistili jsme jejich dlouhodobou mortalitu a počet transplantací srdce. Dlouhodobé přežití bylo ovlivněno komplexitou vady, počtem výkonů při korekci, použitím Mustardovy techniky a bezprostředním výskytem trikuspidální regurgitace po operaci.

Předběžná náplň práce v anglickém jazyce

Maximal oxygen uptake during cardiopulmonary exercise test determines decision about pregnancy, therapeutic measures and timing of surgery and heart transplantation. Atrial correction of transposition of great arteries places right ventricle in the systemic positon. The aim of our work was to assess relation of parameters of function of systemic right ventricle to maximal oxygen uptake. 86 patients after Senning correction were subjected to testing of NYHA class, blood tests of NT-proBNP, Holter monitoring and cardiopulmonary exercise test. Systolic function of right ventricle was assessed semiquantitatively by echocardiography and precisely calculated by heart MRI. Maximal oxygen uptake was not associated with NYHA, NT-proBNP nor systolic function of systemic right and subpulmonary left ventricles. The only parameter associated with VO2max was heart rate reserve. Systolic function of the systemic right ventricle is likely only one integral part of a more complex haemodynamic mechanism of total heart output and its increase during exercise.
In the second part of our study we aimed to ascertain long term mortality of all patients after atrial correction of TGA and its perioperative determinants. We processed perioperative data of all 448 patients and determined long term mortality and transplantation data. Long term mortality was associated with complexity of congenital heart disease and corrective operation, Mustard technique and immediate presence of tricuspid regurgitation after primary operation.