Lung Function in Congenital Heart Disease

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

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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, .