全腔静脉-肺动脉直接连接术后的心脏磁共振综合评估  

Integrated evaluation for patients with direct cavopulmonary connection by cardiac magnetic resonance

作　　者：钟小梅[1] 黄美萍[2] 袁海云[2] 谢佳均 庄建[2] 张杰[1] 郑君惠[1] 梁长虹[1] 刘辉[1] ZHONG Xiao-mei;HUANG Mei-ping;YUAN Hai-yun;XIE Jia-jun;ZHUANG Jian;ZHANG Jie;ZHENG Jun-hui;LIANG Chang-hong;LIU Hui(Department of Radiology,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guang zhou 510080,China;Guangdong Provincial Key Laborafory of South China Structural Heart Disease,Guang dong Cardiovascular Institute,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guang zhou 510080,China)

机构地区：[1]广东省人民医院(广东省医学科学院)放射科,广州510080 [2]广东省华南结构性心脏病重点实验室广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2017年第6期722-725,789,共5页South China Journal of Cardiovascular Diseases

基　　金：广州市科技计划项目(项目编号:201707010306;201510010255);国家自然-广东联合基金重点支持项目(项目编号:U1401255);广东省科技计划项目(项目编号:2013B031800006);广东省医学科学技术研究基金(项目编号:A2017253)

摘　　要：目的探讨全腔静脉-肺动脉直接连接术(direct cavopulmonary connection,DCPC)术后患者的预后及心脏磁共振(cardiac magnetic resonance,CMR)在先天性心脏病术后复查中应用的可行性。方法对12例因复杂先天性心脏病行DCPC术后的患者进行CMR检查,观察上、下腔静脉分别与肺动脉的吻合口是否通畅,并测量吻合口面积、主心室功能及主动脉、左肺动脉、右肺动脉、上腔静脉、下腔静脉的血流量,计算肺动脉指数(pulmonary artery index,PAI)及主-肺侧支(aortopulmonary collaterals,APC)血流量,分析上腔静脉与下腔静脉血流量之和[全腔静脉-肺动脉连接术(total cavopulmonary connection,TCPC)血流量]分别与年龄、体表面积的相关性。结果 CMR图像显示上、下腔静脉与肺动脉的吻合口均通畅,吻合口面积分别为(152.46±46.21)mm^2、(157.60±50.08)mm^2;主心室舒张末容积指数为(58.46±25.07)mL/m^2;射血分数为49.57%±6.40%;PAI为(279.35±26.30)mm^2/m^2;APC血流量为(0.46±0.32)L/(min·m^2),占主动脉博出量1%~32%。TCPC血流量与年龄(r=0.706,P=0.01)、体表面积(r=0.812、P=0.001)间均呈正相关。结论 CMR检查结果显示DCPC术后中远期效果令人满意;CMR检查具有多种优势,可满足先天性心脏病术后综合评估要求,具有非常实用的临床价值。Objectives To investigate the outcome of direct cavopulmonary connection(DCPC)and the role of cardiac magnetic resonance(CMR)in the postoperative evaluation for patients with congenital heart diseases.Methods CMR was performed on12patients who underwent a DCPC operation for complex congenital heart diseases.The direct con?nections between vena cava and pulmonary artery were observed.The cross-sectional area of anastomosis between vena cava and pulmonary artery(PA),function parameters of dominant ventricle,blood flow of aorta,left pulmonary artery(LPA),right pulmonary artery(RPA),superior vena cava(SVC)and inferior vena cava(IVC)were measured.Then the pulmonary artery index(PAI)and the blood flow of aortopulmonary collaterals(APC)were calculated.Correlation analysis for the blood flow in SVC and IVC[total cavopulmonary connection(TCPC)flow]was performed with age and body surface area(BSA).Results The cross-sectional area of anastomosis between SVC and PA was(152.46±46.21)mm2,and(157.60±50.08)mm2for IVC and PA.All the anastomosed sites were unobstructed.End-diastole vol?ume index(EDVI)and ejection fraction(EF)of the dominant ventricle were(58.46±25.07)mL/m2and49.57%±6.40%,respectively.PAI was(279.35±26.30)mm2/m2and APC flow was(0.46±0.32)L/(min·m2),which accounts for1%to32%of the aorta flow volume.There was positive correlation between TCPC flow with age(r=0.706,P=0.01)and between TCPC flow with BSA(r=0.812,P=0.001).Conclusions Results of CMR show that midterm and longterm outcomes of DCPC are favorable.CMR has multiple advantages and can do the integrated evaluation for patients with congenital heart diseases after operation.

关 键 词：心脏缺损 先天性 磁共振成像 FONTAN手术 

分 类 号：R541.1[医药卫生—心血管疾病]