大动脉调转术后解剖左心室功能与构型改变的超声心动图评价  

Evaluation of left ventricular geometry and function by echocardiography in patients after arterial switch operation

作　　者：张玮婧[1] 谢明星[1] 卢晓芳[1] 胡晓青[1] 

机构地区：[1]华中科技大学同济医学院协和医院超声影像科湖北省分子影像重点实验室,武汉430022

出　　处：《中华超声影像学杂志》2013年第3期185-189,共5页Chinese Journal of Ultrasonography

摘　　要：目的二维超声心动图（2DE）评价完全型大动脉转位（D-TGA）大动脉调转术（AS（））后早、中期解剖左室功能和构型改变。方法2DE追踪随访20例室间隔完整型完全型大动脉转位（TGA／IVS）行ASO术患儿。根据检查时年龄是否达到6月分为术后早期组和术后中期组。另选取性别、年龄与之匹配的健康婴幼儿分别设置对照1组和对照2组。2DE测量左室舒张末期后壁厚度（PWTd）、内径（LVIDd）及长径（L），左室舒张末期容积（EDV）、左室收缩末期容积（ESV），计算左室射血分数（LVEF）。频谱多普勒测量二尖瓣口舒张期血流频谱E峰速度、A峰速度及E／A。组织多普勒于室间隔基底段测量等容舒张时间（IVRT）并计算标化等容舒张时间（IVRTn）、室壁厚度指数（PWTd／LVIDd）、几何构型指数（LVIDd／L）。结果①PWTd值术后早期组大于对照1组[（0．41±0．06）cm对（0．36±0．05）cm，P=0．022]，LVIDd值两组间差异无统计学意义[（2．08±0．21）cm对（2．21±0．23）cm，P=0．117]，PWTd／L VIDd术后早期组大于对照1组（0．20±0．04对0．16±0．01，P=0．001）；②PWTd、LVIDd、PWTd／LVIDd术后中期组与对照2组比较差异均无统计学意义（P〉0．05）；③随着术后解剖左室发育，EDV、ESV、L、LVIDd逐渐增加且均与术后随访时年龄呈显著正相关，r值分别为0．90、0．83、0．73、0．90，P值均约0．000，R^2。分别为0．809、0．694、0．528、0．808，而PWTd与术后随访时年龄相关性不显著（r=0．56，P=0．000，R^2=0．309）。结论TGA／IVS患儿ASO术后早期左室壁稍厚；术后中期解剖左室功能及构型恢复至正常，提示最佳手术时期内手术可避免心肌纤维发生不可逆转的病理性改变，术后解剖左室发育良好。Objective To study the early and mid-term outcome in terms of left ventricular（LV） geometry and function in patients with transposition of great arteries with intact ventricular septum （TGA/ IVS） undergoing arterial switch operation. Methods Twenty patients were followed up and divided into 2 groups according to age：the earlier group and the later group. Age and sexual matched controls were also designed as control group 1 and control group 2. LV posterior wall thiekness（PWTd）, dimension（LVIDd） and length（L） at end diastolic phase, LV end-diastolic volume （EDV）, end-systolic volume （ESV）, ejection fraction （EF）, mitraI valve early （E） and late （A） inflow velocities and E/A, isovolumic relaxation time （IVRT） were obtained by two-dimensional echoeardiography, normalized isovolumic relaxation time （IVRTn）,wall thickness index （PWTd/LVIDd） and LV geometry index（LVIDd/L） were calculated, and these indexes between groups were compared. Results ①Compared with control group 1 ,PWTd in earlier group was higher [（0.41 ± 0.06）cm vs （0.36 ± 0.05）cm, P = 0.022],but LVIDd had no significant statistical difference [（2.08 ± 0.21 ） cm vs （2.21 ± 0.23） cm, P = 0.1171, indicating PWTd/ LVIDd differed between groups（0.20 ± 0.04 vs 0.16 ± 0.01 P = 0. 001 ）. ②No abnormalities were observed in later group. ③Compared with different age groups in TGA, EDV, ESV, L, LVIDd, PWTd were significantly higher in later group（ P = 0. 000）. There were obvious correlations between EDV,ESV,L,LVIDd and examined age（r =0.90,0.83,0.73,0.90, P = 0. 000,R^2 = 0. 809,0. 694,0. 528,0. 808） while there were no significant correlation between PWTd and examined age（ r = 0.56, P = 0. 000,R^2 = 0.309）. Conclusions Early after operation,LV is undergoing hypertrophy or hyperplasia in TGA/IVS, but will recover in the mid-term period,and the function is normal all the time indicating that the LV myocardium may avoided irreversible pathological changes if operated in

关 键 词：超声心动描记术 心室功能 左 心脏缺损 先天性 完全性大动脉转位 大动脉调转术 

分 类 号：R726[医药卫生—儿科]