BACKGROUND Patients with large hiatal hernias (HH) frequently experience postprandial dyspnea. The aim of this study was to evaluate whether feeding induced cardiac compression in these patients using echocardiography. METHODS Transthoracic echocardiography was performed during fasting and 30 min after feeding (300 g rice pudding) in patients with HHs (n = 32; mean age, 72 ± 9 years). A subset of patients (n = 15; mean age, 76 ± 6 years) were evaluated postoperatively. RESULTS Preoperatively, feeding decreased left atrial (LA) volumes (maximal 27.4 ± 11.3 vs 19.2 ± 9.7 mL/m2, P < .001; minimal 13.1 ± 7.0 vs 6.9 ± 5.1 mL/m2, P < .001), and increased LA inflow velocities (systolic wave 0.62 ± 0.14 vs 0.77 ± 0.17 m/sec, P < .01; diastolic wave 0.46 ± 0.13 vs 0.59 ± 0.13 m/sec, P < .01), mitral inflow velocities (E wave 0.79 ± 0.17 vs 0.94 ± 0.19 m/sec, P < .01; A wave 0.93 ± 0.20 vs 1.05 ± 0.22 m/sec, P < .01), and E/E' ratio (12.1 ± 2.7 vs 13.7 ± 3.9, P < .01). Cardiac output (6.3 ± 1.6 vs 7.24 ± 2.0 L, P < .01) increased postprandially by marked heart rate augmentation (68.8 ± 7.0 vs 84.2 ± 8.4 beats/min, P < .01), with modest stroke volume increase (88.5 ± 16.7 vs 94.3 ± 19.5 mL, P = .03). After HH surgery, feeding did not change LA volumes (maximal 52.9 ± 13.6 vs 53.4 ± 12.5 mL, P = .89; minimal 28.6 ± 12.2 vs 27.4 ± 8.7 mL, P = .59) or E/E' ratio (10.9 ± 2.1 vs 11.3 ± 2.3) and induced more modest alterations in LA inflow (systolic wave 0.58 ± 0.17 vs 0.68 ± 0.16 m/sec, P = .01; diastolic wave 0.41 ± 0.12 vs 0.47 ± 0.13 m/sec, P = .01) and mitral inflow (E wave 0.69 ± 0.15 vs 0.80 ± 0.13 m/sec, P < .01; A wave 0.92 ± 0.13 vs 1.01 ± 0.18 m/sec, P = .02). Postoperatively, feeding increased cardiac output by substantial stroke volume augmentation (81.9 ± 16.5 vs 90.8 ± 16.0 mL, P = .01), with only modest increase in heart rate (69.8 ± 9.1 vs 75.9 ± 10.5 beats/min, P < .01). CONCLUSIONS Feeding produces marked LA compression in patients with HHs, inducing compensatory exaggerated responses in cardiac inflow and hemodynamic status. These compensatory mechanisms improve postoperatively following resolution of LA compression, likely explaining the debility noted preoperatively.

中文翻译：

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进食可导致大食管裂孔疝患者左房压迫并阻碍心脏充盈。

背景大食管裂孔疝（HH）的患者经常经历餐后呼吸困难。这项研究的目的是评估是否使用超声心动图检查这些患者的进食是否引起心脏压迫。方法对HHs（n = 32；平均年龄：72±9岁）的患者在禁食和进食（300 g大米布丁）后的30分钟内进行胸腔超声心动图检查。术后评估了一部分患者（n = 15；平均年龄为76±6岁）。结果术前喂养减少了左心房（LA）体积（最大27.4±11.3 vs 19.2±9.7 mL / m2，P <.001;最小13.1±7.0 vs 6.9±5.1 mL / m2，P <.001），并且LA增加流入速度（收缩波0.62±0.14 vs 0.77±0.17 m / sec，P <.01;舒张波0.46±0.13 vs 0.59±0.13 m / sec，P <.01），二尖瓣流入速度（E波0.79±0.17 vs 0。94±0.19 m / sec，P <.01; 波动0.93±0.20 vs 1.05±0.22 m / sec，P <.01）和E / E'比（12.1±2.7 vs 13.7±3.9，P <0.01）。餐后心脏输出功率明显增加（6.3±1.6 vs 7.24±2.0 L，P <.01）（68.8±7.0 vs 84.2±8.4次/ min，P <.01），搏动量适度增加（88.5±） 16.7对94.3±19.5 mL，P = .03）。HH手术后，进食并没有改变LA容积（最大52.9±13.6 vs 53.4±12.5 mL，P = 0.89;最小28.6±12.2 vs 27.4±8.7 mL，P = 0.59）或E / E'比（10.9± 2.1 vs 11.3±2.3）并引起LA流入的更适度变化（收缩波0.58±0.17 vs 0.68±0.16 m / sec，P = 0.01；舒张波0.41±0.12 vs 0.47±0.13 m / sec，P = 0.01 ）和二尖瓣流入（E波0.69±0.15 vs 0.80±0.13 m / sec，P <.01; A波0.92±0.13 vs 1.01±0.18 m / sec，P =。02）。术后，进食可通过大幅增加搏动量来增加心排血量（81.9±16.5 vs 90.8±16.0 mL，P = .01），而心率仅适度增加（69.8±9.1 vs 75.9±10.5次/分钟，P <.01 ）。结论进食会在HHs患者中产生明显的LA压迫，导致心脏流入和血流动力学状态的代偿性夸张反应。这些补偿机制改善了LA压缩后的术后效果，可能解释了术前注意到的虚弱。引起心脏流入和血液动力学状态的代偿性夸张反应。这些补偿机制改善了LA压缩后的术后效果，可能解释了术前注意到的虚弱。引起心脏流入和血液动力学状态的代偿性夸张反应。这些补偿机制改善了LA压缩后的术后效果，可能解释了术前注意到的虚弱。