Andersons pediatric cardiology 1132
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (140.65 KB, 3 trang )
FIG.42.40 BethesdaClassificationofsports.Thelowesttotal
cardiovasculardemands(cardiacoutputandbloodpressure)areshownin
greenandthehighestinred.Blue,yellow,andorangedepictlowmoderate,moderate,andhigh-moderatetotalcardiovasculardemands.
*Dangerofbodilycollision.†Increasedriskifsyncope.(FromMitchellJH,
HaskellW,SnellP,etal.TaskForce8:Classificationofsports.JAm
CollegeCardiol.2005;45:1364–1367.)
AsymptomaticpatientswithuntreatedpulmonarystenosiswithpeakDoppler
systolicgradientsoflessthan40mmHgareencouragedtoliveanormallife,
includinganycompetitivesports.Patientswithgradientsgreaterthan40mmHg
canparticipateinlow-intensitycompetitionbutwouldusuallybeconsideredfor
intervention.
AfterInterventionforPulmonaryStenosis
Followingballoondilation,thereturntoallcompetitivesportscanbecounseled
inpatientswithnoormildresidualstenosis2to4weeksaftertheprocedure.A
longerintervalofabout3monthsisrecommendedaftersurgicalrelief.Those
withresidualmoderatepulmonarystenosis,withagradientofgreaterthan40
mmHg,shouldfollowthesamerecommendationsaspatientspriorto
intervention.Patientswithseverepulmonaryincompetenceandrightventricular
enlargementarerecommendedonlytoparticipateinIAandIBclassifiedsports.
Caretoavoidblowstothechestwouldbeprudent.159
ImplicationsinAdultLife
Withoutintervention,patientswithpulmonarystenosiscansurviveintoadult
life,astheygenerallydoincountrieswithlesswell-developedhealthcare
systems.Inaretrospectivestudyof20yearsinadevelopingcountry,pulmonary
stenosisaccountedfor6%ofunoperatedadultspresentingwithcongenitally
malformedhearts.161Althoughtherearefewdataintheliterature,persistentand
slowlyprogressiveobstructionoftherightventricularoutflowtracthasledto
anecdotalreportsofseverelydebilitatedpatientswithlowcardiacoutputand
rightheartfailure,particularlyindevelopingcountries.Thesameanecdotal
reportsshowthat,despitecatastrophicexistingmorbidity,asuccessful
interventiontorelievepulmonarystenosiscanyieldrapidandimpressive
improvementsintheclinicalstate.
