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Lung Function in Congenital Heart Disease Leonard M. Linde, Sidney I. Siegel, Robert R. Martelle and Daniel H. Simmons Dis Chest 1964;46;46-50 DOI 10.1378/chest.46.1.46
The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://www.chestjournal.org/content/46/1/46
CHEST is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright 2007 by the American College of Chest Physicians, 3300 Dundee Road, Northbrook IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://www.chestjournal.org/misc/reprints.shtml) ISSN:0096-0217
Downloaded from www.chestjournal.org on February 6, 2009 Copyright 1964, by the American College of Chest Physicians
Lung
Function M.
LEONARD
R.
ROBERT
in Congenital LINDE,
MARTELLE,
M.D.,
M.D.
Los
AND
Heart
SIDNEY
I.
H.
DANIEL
Angeles,
Disease*
SIEGEL,
M.D.,
SIMMONS,
M.D.,
F.C.C.P.
volume
of
California
INTRODUCTION
T
HE
IMPORTANCE
understanding culation
and
lung
increasingly
in
nary vascular This stud whether
of
bed,’ was
changes
in
studied.
were
flow from
surgical
correction
fects, None of
All were
There
ventricular
septal
al)normalitics
(including patent aortic stenosis, pulmonic
atrio-vcntricular ralogy), murmurs. right
various
other
and
canal,
and
to
de-
volume
were
spirometer
um
dilution
on
level
ductus arstenosis,
the
The
and
data
were
compared
normal
surgery.
with
a 9 liter
Col-
50
heliin-
compared (less
thc Departments of Pediatrics, Physiology and Medicine, UCLA School 01 Medicine. ‘I’his investigation was supported in part h Public Health Service Research Grants USPH
per than was
those
50
per
made
pulmonary Hg,
35 and
with
atrial
and
Values
for
those
greater
systemic
cent).
among
children Findings
(shunts with
artery
between
50 mm.
HTS.5357.
children
total
of
expected
for
murmurs.
defects.
to
congenital to
those
shunts
cent
cent
between
with
to
for
be
groups.
heart septal
could 5 per
compared
and
significant
of
patients
were
values
of total lung closed circuit Measurements
control
for
disease
so
A two-sided
differences
evaluate
as
values
heights
basis.
to
*From
and
same
a significant
cardiac
RV/TLC
expressed
used
son
11.5125
varying
the
av-
found by and Sim-
normal
of
figures labora-
our
ratios
were
with
ventricular
using
the
was
tet-
by
values
test’
catheterization
and the technique.5
for
expected
children
compared
to in
control
Results of
functional
measured
reported
below levels of Andrewes
used
were
with
subdivisions
these
FRC/TLC.
percentage
METHODS
lins
general,
eight with innocent functional Diagnoses were established at
various
deand with
15 per cent The values
mons7
that
or
values were compared in normal children In
and
severe
were initially studied children agreed well
congenital
and/or
capacity
et al.4
eraged Ferris.”8
or
acyanotic
to-
residual
lung
series of normals
heart
heart
l’he
larger
tory.7
Medical
six with lesions (mainly tet-
18
total
disease
illness for these
MVV obtained
years
failure at the
ralogv), teriosus,
with
(ASD), shunts
functional
and
cardiopulmonary
bilitating values
14 patients with (VSD), 16 with
defects
atrial septal defects causing right-to-left
of
Hellieson,
heart
(V02),
or forced exand 24 second (MVV), re-
(TLC). A series of “hospital normal” children consisting of those without evidence
lungs. 17
(RV),
(FRC)
the
catheterization
were
volume
capacity
vascula-
admitted
congenital
of
sidual
respiration
consumption
and
function
UCLA
in congestive
was
study.
the six to to
oxygen
timed vital capacity pired volume (FEy), 12 maximal ventilatory volume
and
the pulmonary
in
the pediatric service at the Center either for cardiac
time
tal
to determine
ventilatory
minute
(MVR),
become
diagnosis
designed
alterations
age
cluded
AN
cir-
has
the
in
and altered blood Sixty-two children
ture
ACQUIRING
pulmonary
of children with congenital heart Complicating heart failure and are related to pulmonary blood patients with left-to-right shunts. after surgical repair is dependent cases on the status of the pulmo-
Outcome ill many
reflect
OF
the
function
apparent
treatment disease,’ pneumonia flow
of
flow)
very Another
50 mm.
Hg.
46
Downloaded from www.chestjournal.org on February 6, 2009 Copyright 1964, by the American College of Chest Physicians
were
small
children
pressures
than shunts
compariwith
below Hg
systolic 35
and
mm. above
Volume 46, July 1964
No.
I
LUNG
FUNCTION
IN
CONGENITAL
In
Table
1,
TABLE IN
data
OF
WITH
WITH
children
are
1-COMPARISON
CHILDREN
STUDIES
MURMURS
HEART
of Patients
Errors)
54
99±
5.0
89±2.4 89±2.9
MVV FRC
101±
RV
117±14.4
TLC FRC/TLC*
103±
3.4
101±3.1
112±
5.3
123±2.6
RV/TLC**
105±
7.0
126±4.8
108±3.8
9.4
marked
difference
groups. Table
3,
All
study
indicate
(5%
significant
difference
level).
figures
are
per
cent
of predicted
nor-
mal.
data
from
(CHD).
patients
with
different children
functional
MVV
murmurs
congenital
significant
and
findings
in
were
not
normal values in our laboraother hand, in the group
with
were
heart
congenital
Ventilatory
from On the
tory.
with
patients
disease
heart
significant
in
of
Although
a trend in VC,
increasing
size
was
noted
FRC, of
RV
shunt,
2-COMPARISON
IN
CHILDREN
no
OF WITH
(Means
and
nor-
FRC/TLC elevated.
No
between lung
the
volumes
SEPTAL
DEFECTS
Standard
Errors)
StudiesVSD
Standard
HYPER-
Errors)
dif-
13
8
79±
3.6
5.1
80±
5.8
96±
7.3
6.5
106±
5.4
83±
8.8
FRC
114±
RV
130±10.6
TLC
106±
4.9
FRC/TLC
125±
4.2
RV/TLC
109±10.9
All
study
figures
reduction differences
the
89±13.7 6.1
82±
121±
3.0
111±11.2
122±
8.7
117±14.8
cent
of
most
over
predicted
reduction
striking
findings.
50 mm.
in with
4-SUMMARY
ABNORMALITIES
Hg showed
VC,
marked groups.
FRC,
increasing
OF IN
5.0
normal.
in all lung volumes with in FRC among all three
TLC is seen hypertension.
nary
95±
per
PAP
Progressive and
STUDIES
114±13.5
are
FRC
with
PAP>50
35-50
4.5
in
greater
PAP
86±
shows
statistical
VENTILATORY
and
STUDIES
PULMONARY
3.5
with
TLC
VENTILATORY
OF
92± 91±
(PAP),
INTERVENTRICULAR
INTERATRIAL
RV.
artery pressure
28
Patients
Patients
for
and
of
TABLE TABLE
and than
VC MVV
and
increases
OF
mm.Hg
there
RV.
reduction
FRC lower
compares
(Means
VC
disease,
reductions
and
found
with are de-
PAP(35 No.
normal
is
3-COMPARISON TO DEGREE
ACCORDING TENSION
Studies
figures
defects trends to
the are
the basis of pulmonary
TABLE
*Expected=44 Underlined
and
ratios
which
patients
125±6.2
**Expected=24 from
groups,
RV/TLC
on
in
septal show
increased
dem-
was
subdivisions
is significantly
both
in
and
CHD
100±11.2
the
and
MVV
mal All 8
VC
VC
creased
Only
Functional Murmur
Studies
AND
DISEASE
Standard
47
In Table 2, findings atrial and ventricular compared. Both groups
with
VENTILATORY
CONGENITAL
and
with
compared
FUNCTIONAL
(Means
No.
from
murmurs
DISEASE
ference between onstrated.
RESULTS
functional
HEART
RV pulmo-
SIGNIFICANT
VENTILATORY
STUDIES
AND
ASD
F-
.n
.9
0.
C,.’
Q .,-,
v
.e.’
‘(I
A
0, .