超声心动图评估婴儿室间隔完整型肺动脉闭锁与手术决策及术后右心室发育  

Echocardiographic evaluation on infants with pulmonary atresia and intact ventricular septum:Surgical decision and post operation right ventricle development

作　　者：杨静[1] 丁文虹[1] 王强[1] 李斌[1] 吴永涛[1] 孙跃坤 胡振波 YANG Jing;DING Wenhong;WANG Qiang;LI Bin;WU Yongtao;SUN Yuekun;HU Zhenbo(Department of Pediatric Heart Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Ultrasound,Chifeng Obstetrics and Gynecology Hospital,Chifeng 024005,China)

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,北京100029 [2]赤峰市妇产医院超声科,内蒙古赤峰024005

出　　处：《中国医学影像技术》2024年第11期1672-1676,共5页Chinese Journal of Medical Imaging Technology

基　　金：首都卫生发展科研专项(首发2024-1-2062)。

摘　　要：目的 观察基于超声心动图参数选择不同手术方式治疗婴儿室间隔完整型肺动脉闭锁(PA/IVS)与术后评价右心室(RV)发育的价值。方法 回顾性分析接受基于超声心动图参数选择的不同手术方式治疗,包括肺动脉(PV)成形术(A组,n=25)、PV成形+RV流出道疏通或+体肺分流术(B组,n=15),以及体肺分流术+房间隔扩大术(C组,n=6)的46例PA/IVS婴儿,比较组间术前及术后1、6个月右心发育状况。结果 B组就诊日龄小于、C组则大于A组(P均<0.05)。术前B、C组三尖瓣(TV)瓣环径、TV瓣环径Z值及TV/二尖瓣(MV)瓣环径比值均小于A组,B组RV/左心室(LV)上下径比值大于、C组PV瓣环径Z值小于A组(P均<0.05);且B组PV瓣环径Z值及RV/LV上下径比值均大于C组(P均<0.05)。术后1个月,B、C组TV瓣环径、TV瓣环径Z值、TV/MV瓣环径比值,以及C组PV瓣环径、PV瓣环径Z值及RV/LV上下径比值均小于A组(P均<0.05);且C组PV瓣环径、PV瓣环径Z值及RV/LV上下径比值均小于B组(P均<0.05)。术后6个月,A、B组间TV瓣环径、PV瓣环径、PV瓣环径Z值、TV/MV瓣环径比值及RV/LV上下径比值差异均无统计学意义(P均>0.05),而C组上述参数均低于前两组(P均<0.05);此外,A、B组间TV瓣环径Z值差异无统计学意义(P>0.05)而C组TV瓣环径Z值低于A组(P<0.05)。结论 超声心动图评估婴儿PA/IVS有助于及时建立经RV-肺动脉前向血流、促进RV发育。Objective To observe value of echocardiographic evaluation on infants with pulmonary atresia and intact ventricular septum(PA/IVS)for surgical decision and post operation right ventricle(RV)development.Methods Forty-six PA/IVS infants who underwent pulmonary valve(PV)annuloplasty(group A,n=25),PV annuloplasty and RV outflow tract reconstruction with/without additional systemic-to-pulmonary artery shunt(group B,n=15),and systemic-to-pulmonary artery shunt and atrial septal enlargement(group C,n=6)were retrospectively enrolled.Status of RV developments were compared among groups before operation as well as 1 and 6 months after operation.Results The presentation age in group B was younger than,while in group C was older than that in group A(both P<0.05).Before operation,tricuspid valve(TV)annulus diameter,TV annulus Z-score and TV/mitral valve(MV)annulus ratio in groups B and C were both smaller than those in group A(all P<0.05),whereas RV/left ventricle(LV)longitudinal diameter ratio in group B was larger and PV annulus Z-score in group C was smaller than those in group A(both P<0.05).Meanwhile,preoperative PV annulus Z-score and RV/LV longitudinal diameter ratio in group B were both larger than those in group C(both P<0.05).One month after operations,TV annulus diameter,TV annulus Z-score and TV/MV annulus ratio in group B and C,as well as PV annulus diameter,PV annulus Z-score and RV/LV longitudinal diameter ratio in group C were all smaller than those in group A(all P<0.05),while PV annulus diameter,PV annulus Z-score and RV/LV longitudinal diameter ratio in group C were all smaller than those in group B(all P<0.05).Six months after operations,no significant difference of TV annulus diameter,PV annulus diameter,PV annulus Z-score,TV/MV annulus ratio nor RV/LV longitudinal diameter ratio was found between group A and B(all P>0.05),but the above indexes in group C were all lower than those in group A and B(all P<0.05).Besides,no significant difference of TV annulus Z-score was found between group A and B(P>0.05),w

关 键 词：室间隔完整型肺动脉闭锁 肺动脉瓣 超声心动描记术 

分 类 号：R542.5[医药卫生—心血管疾病] R540.45[医药卫生—内科学]