超声心动图在矫正型大动脉转位诊断及双调转术效果评估中应用价值  

Value of echocardiogram to the diagnosis of corrected transposition of the great arteries and the assessment of double switch operation

作　　者：吴力军[1] 张玉奇[2] 陈亚青[1] 陈丽君[2] 刘贻曼 WU Li-jun;ZHANG Yu-qi;CHEN Ya-qing;CHEN Li-jun;LIU Yi-man(Department of Echocardiography,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;Department of Cardiology,Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属新华医院超声科,上海200092 [2]上海交通大学医学院附属上海儿童医学中心心内科,上海200127

出　　处：《中华实用诊断与治疗杂志》2023年第4期410-413,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金青年基金(82001835);上海交通大学“交大之星”计划医工交叉研究基金(YG2019QNB03)。

摘　　要：目的分析行双调转术的矫正型大动脉转位(corrected transposition of the great arteries,CTGA)患儿手术前、后超声心动图资料,探讨超声心动图在CTGA诊断及手术效果评估中的应用价值。方法78例CTGA患儿均行双调转术,其中42例行Senning+大动脉调转术,36例行Senning+Rastelli术。术前及术后1年行超声心动图检查,记录右心室心肌做功指数,评估三尖瓣反流程度,观察术后残余分流、肺静脉梗阻、腔静脉梗阻、左心室流出道梗阻、右心室流出道梗阻、心功能不全等并发症发生情况。结果78例患儿术前超声心动图诊断准确72例(92.31%);误诊6例(7.69%),其中5例误诊为右心室双出口,1例误诊为完全性大动脉转位。78例患儿术后右心室心肌做功指数(0.36±0.11)及中重度三尖瓣反流比率(15.38%)均低于术前(0.48±0.16、34.61%)(t=7.321,P=0.037;Z=-2.880,P=0.004)。78例患儿中术后发生残余分流12例(15.38%),肺静脉梗阻7例(8.97%),腔静脉梗阻3例(3.85%),左心室流出道梗阻7例(8.97%),右心室流出道梗阻14例(17.95%),心功能不全12例(15.38%)。结论双调转术可改善CTGA患儿右心室功能,减轻三尖瓣反流;超声心动图在CTGA术前诊断及手术效果评估中有较高价值。Objective To analyze the echocardiographic images in children with corrected transposition of the great arteries(CTGA)before and after double switch operation,and to investigate the value of the echocardiography to the diagnosis of CTGA and the assessment of surgical outcome.Methods In 78 children receiving double switch operation,42 were performed Senning+arterial switch operation,and 36 children were performed Senning+Rastelli procedure.Echocardiography was done before and one year after operation.The myocardial performance index was recorded and the degree of tricuspid regurgitation was evaluated.The postoperative complications were observed as residual shunt,pulmonary vein obstruction,vena cava obstruction,left ventricular outflow tract obstruction,right ventricular outflow tract obstruction,and heart dysfunction.Results In 78 patients,72(92.31%)were diagnosed correctly,6(7.69%)were misdiagnosed,in which 5 were misdiagnosed with double outlet right ventricle and 1 was misdiagnosed with complete transposition of the great arteries.The myocardial performance index of right ventricle and the rate of moderately severe tricuspid regurgitation decreased from 0.48±0.16 and 34.61%preoperatively to 0.36±0.11 and 15.38%postoperatively(t=7.321,P=0.037;Z=-2.880,P=0.004).The postoperative complications included residual shunt in 12 patients(15.38%),pulmonary vein obstruction in 7(8.97%),vena cava obstruction in 3(3.85%),left ventricular outflow tract obstruction in 7(8.97%),right ventricular outflow tract obstruction in 14(17.95%),and heart dysfunction in 12(15.38%).Conclusions The double switch operation can improve the right ventricular function,and relieve the severity of tricuspid regurgitation.Echocardiography has a high value to the preoperative diagnosis of CTGA and the assessment of surgical outcome.

关 键 词：矫正型大动脉转位 双调转术 超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]