基于Z值的膜部室间隔缺损经皮介入封堵术后,心脏几何构型改变的中远期随访  

Medium to long term follow-up of cardiac geometrical changes based on Z scores after percutaneous interventional treatment of the perimembranous ventricular septal defect

作　　者：郭恩玉 王本臻[1] 李自普[1] GUO Enyu;WANG Benzhen;LI Zipu(Heart Center,Qingdao Women and Children Hospital Affiliated Qingdao University,Qingdao 266034,China)

机构地区：[1]青岛大学附属妇女儿童医院心脏中心,266034 [2]山东省济宁市第一人民医院儿科

出　　处：《心肺血管病杂志》2020年第6期667-671,686,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：青岛市医疗卫生优秀人才培养项目资助(青卫科教字[2017]4号)。

摘　　要：目的:了解基于Z值的膜部室间隔缺损(PMVSD)经皮介入封堵术后心脏几何构型改变的中远期结果。方法:回顾性分析33例PMVSD患儿经皮介入封堵治疗后1、3、6个月以及术后1、2、3、4、5、6年的LVEDd、室间隔舒张期厚度(IVSd)、左心室后壁厚度(LVPWd)、左心室质量(LVM)和左心室容量(LVEDV)的Z值以及左心室质量指数(LVMI)、左心室重性指数(LVRI)和左右心室舒张末期内径比值(LVEDd/RVEDd)的变化规律。结果:33例PMVSD患儿经皮介入封堵后,反映左心室结构纵向改变指标LVEDd/RVEDd比值和LVEDd Z值于术后1个月明显下降(P<0.05),分别于术后1年和2年后趋于稳定;而IVSd和LVPWd的Z值于术后6个月开始明显下降(P<0.05),但术后3年后趋于稳定。反映左心室肥厚和扩张程度的指标LVMI和LVM Z值于术后3个月明显下降(P<0.05),分别于术后2年和3年后趋于稳定;而LVEDV Z值于术后1个月明显下降(P<0.05),术后2年后趋于稳定。反映左心室重构方向的指标LVRI于术后6个月明显下降(P<0.05),于术后2年后趋于稳定。结论:PMVSD经皮介入封堵后,有利于其心脏几何构型逆向重构,且其改变随着随访时间的延长而趋于稳定。Objective:After percutaneous interventional treatment of the perimembranous ventricular septal defect(PMVSD),the mid-to-long-term changes in cardiac geometry are explored based on Z scores.Method:33 children with PMVSD were underwent percutaneous interventional treatment.The changes of Z scores for LVEDd,interventricular septal diastolic thickness(IVSd),left ventricular posterior wall thickness(LVPWd),left ventricular mass(LVM),left ventricular volume(LVEDV),as well as left ventricular mass index(LVMI),left ventricular remodeling index(LVRI),and left and right ventricular end-diastole diameter ratio(LVEDd/RVEDd)at 1 m,3 m,6 m and 1 y,2 y,3 y,4 y,5 y,6 y after surgery were retrospectively analyzed.Result:The LVEDd/RVEDd ratio and LVEDd Z scores,which reflect longitudinal changes in left ventricular structure,decreased significantly at 1 month after operation(P<0.05),and were stable after 1 year and 2 years after operation.The Z scores of IVSd and LVPWd,which reflect longitudinal changes in left ventricular structure,decreased significantly after 6 months(P<0.05),and were stable after 3 years.The LVMI and LVM Z scores,which reflect the degree of left ventricular hypertrophy,decreased significantly after 3 months(P<0.05),and were stable after 2 and 3 years.The LVEDV Z scores,which reflect the degree of left ventricular dilation,decreased significantly at 1 month after operation(P<0.05),and were stable after 3 years.The LVRI,which reflects the direction of left ventricular remodeling,decreased significantly at 6 months after surgery(P<0.05)and were stable after 2 years after surgery.Conclusions:Percutaneous interventional treatment of PMVSD is conducive to the reverse remodeling of cardiac geometry,and the changes tend to stabilize as the follow-up time increases.

关 键 词：室间隔缺损 介入治疗 Z值 心脏重塑 儿童 

分 类 号：R54[医药卫生—心血管疾病]