Knirsch Walter, Dodge-Khatami Ali, Kadner Alexander, Kretschmar Oliver, Steiner Johannes, Böttler Petra, Kececioglu Deniz, Harpes Paul, Valsangiacomo Buechel Emanuela R
Division of Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland.
Pediatr Cardiol. 2008 Jul;29(4):718-25. doi: 10.1007/s00246-008-9227-y. Epub 2008 May 28.
The global myocardial function in patients after repair of tetralogy of Fallot (TOF) can be assessed by cardiovascular magnetic resonance (CMR) and measurement of B-type natriuretic peptides. Two-dimensional echocardiography-derived strain and strain rate (2D strain) facilitate the assessment of regional myocardial function. We evaluated myocardial function in 16 children with residual severe pulmonary valve regurgitation and right ventricular (RV) volume overload after TOF repair before, 1 month after, and 6 months after pulmonary valve replacement (PVR). In 2D strain echocardiography preoperatively, the longitudinal systolic RV strain was reduced (p < 0.05). One month after PVR, longitudinal systolic RV strain decreased further (p < 0.05), while systolic and early diastolic radial left ventricular strain and strain rate increased (each p < 0.05), followed by a return toward preoperative values after 6 months. Six months after PVR, preoperatively elevated RV end-diastolic volume (p < 0.01) assessed by CMR and N-terminal pro-B-type natriuretic peptide (p < 0.05) decreased. In conclusion, the impairment of the regional myocardial after TOF repair and transient changes after PVR can be subtly analyzed by 2D strain echocardiography in addition to the established assessment of myocardial function with CMR and measurement of B-type natriuretic peptides.
法洛四联症（TOF）修复术后患者的整体心肌功能可通过心血管磁共振成像（CMR）和B型利钠肽测量来评估。二维超声心动图衍生的应变和应变率（二维应变）有助于评估局部心肌功能。我们评估了16例TOF修复术后存在严重肺动脉瓣反流和右心室（RV）容量超负荷的儿童在肺动脉瓣置换术（PVR）前、术后1个月和术后6个月时的心肌功能。在二维应变超声心动图检查中，术前RV纵向收缩期应变降低（p<0.05）。PVR术后1个月，RV纵向收缩期应变进一步降低（p<0.05），而左心室径向收缩期和舒张早期应变及应变率增加（均p<0.05），6个月后恢复至术前值。PVR术后6个月，通过CMR评估的术前升高的RV舒张末期容积（p<0.01）和N末端B型利钠肽原（p<0.05）降低。总之，除了通过CMR和B型利钠肽测量对心肌功能进行既定评估外，二维应变超声心动图还可对TOF修复术后局部心肌的损伤及PVR后的短暂变化进行精细分析。
