用磁共振成像评估Ross手术患者的主动脉根部功能障碍及其对左心室功能的影响。

Aortic root dysfunctioning and its effect on left ventricular function in Ross procedure patients assessed with magnetic resonance imaging.

作者信息

Grotenhuis Heynric B, Westenberg Jos J M, Doornbos Joost, Kroft Lucia J M, Schoof Paul H, Hazekamp Mark G, Vliegen Hubert W, Ottenkamp Jaap, de Roos Albert

机构信息

Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Am Heart J. 2006 Nov;152(5):975.e1-8. doi: 10.1016/j.ahj.2006.06.038.

DOI:10.1016/j.ahj.2006.06.038

PMID:17070172

Abstract

BACKGROUND

This study evaluated the diameters and distensibility of the aortic root as well as the degree of aortic regurgitation (AR) and its effect on left ventricular (LV) function in patients 8.2 +/- 3.1 years after they underwent the Ross procedure, with a comparison of these parameters between patients and matched healthy subjects.

METHODS

Eighteen Ross procedure patients (16 male patients, age [mean +/- SD] 19.2 +/- 3.8 years) and 18 matched healthy subjects (16 male patients, age [mean +/- SD] 19.7 +/- 4.2 years) underwent magnetic resonance imaging. Measurements for diameters (at 4 levels) and the distensibility of the aortic root were performed using a steady-state free precession sequence. Aortic flow was assessed with a velocity-encoded phase-contrast sequence. Left ventricular systolic function was assessed with a gradient-echo sequence in the short-axis plane. Comparison of parameters was performed using the Mann-Whitney U test. Correlations between diameters, distensibility, AR fraction, and LV systolic function were expressed with Spearman rank correlation coefficients. Linear regression analysis was used to identify predictors of LV systolic dysfunction.

RESULTS

Aortic root diameters were increased in Ross procedure patients as compared with healthy subjects (mean difference 6.3-11.6 mm, P < or = .02 at all 4 levels). Distensibility of the aortic root was lower in patients (1.9 +/- 1.1 vs 7.8 +/- 3.3 mm Hg(-1), P < .01). An AR fraction > 5% was present in 14 of the 18 patients (mean AR fraction 8% +/- 5% vs 1% +/- 1%, P < .01). Left ventricular ejection fraction was lower in patients (50% +/- 6% vs 57% +/- 6%, P < .01). Dilatation, decreased distensibility, and AR fraction were correlated with impaired LV systolic function (P < .05 for all). The AR fraction predicted impaired LV systolic function (P < .01).

CONCLUSIONS

Magnetic resonance imaging shows dilatation and decreased distensibility of the aortic root, AR, and consequent impaired LV systolic function in patients after the Ross procedure.

摘要

背景

本研究评估了接受Ross手术8.2±3.1年后患者的主动脉根部直径和扩张性，以及主动脉瓣反流（AR）程度及其对左心室（LV）功能的影响，并将这些参数与匹配的健康受试者进行比较。

方法

18例接受Ross手术的患者（16例男性患者，年龄[均值±标准差]19.2±3.8岁）和18例匹配的健康受试者（16例男性患者，年龄[均值±标准差]19.7±4.2岁）接受了磁共振成像检查。使用稳态自由进动序列测量（4个水平的）直径和主动脉根部扩张性。采用速度编码相位对比序列评估主动脉血流。在短轴平面使用梯度回波序列评估左心室收缩功能。使用Mann-Whitney U检验进行参数比较。直径、扩张性、AR分数和左心室收缩功能之间的相关性用Spearman等级相关系数表示。采用线性回归分析确定左心室收缩功能障碍的预测因素。

结果

与健康受试者相比，Ross手术患者的主动脉根部直径增加（平均差异6.3 - 11.6 mm，所有4个水平P≤0.02）。患者的主动脉根部扩张性较低（1.9±1.1对7.8±3.3 mmHg-1，P<0.01）。18例患者中有14例AR分数>5%（平均AR分数8%±5%对1%±1%，P<0.01）。患者的左心室射血分数较低（50%±6%对57%±6%，P<0.01）。扩张、扩张性降低和AR分数与左心室收缩功能受损相关（所有P<0.05）。AR分数可预测左心室收缩功能受损（P<0.01）。