Fenstermaker Bernadette, Berger Glen E, Rowland Daniel G, Hayes John, Hill Sharon L, Cheatham John P, Galantowicz Mark, Cua Clifford L
The Heart Center, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio, USA.
J Am Soc Echocardiogr. 2008 Nov;21(11):1222-8. doi: 10.1016/j.echo.2008.08.005.
The hybrid procedure is an alternative for initial palliation for patients with hypoplastic left heart syndrome. No echocardiographic data exist for the interstage (IS) period. The goal of this study was to describe the echocardiographic changes during this period.
A chart review was performed on patients discharged from the hospital with the diagnosis of hypoplastic left heart syndrome who underwent hybrid palliation. Echocardiograms at hospital discharge (post-hybrid), before and after any IS interventions, and before comprehensive stage II procedure were reviewed. Distal right pulmonary artery (RPA) and left pulmonary artery (LPA) velocity, slope, velocity time integral (VTI), pressure halftime (p1/2), pulsatility index (PI), and systolic/diastolic (S/D) ratio of the waveforms were recorded. Atrial septal defect (ASD) mean gradient, ductus arteriosus peak velocity, retro-aortic arch peak velocity, tricuspid regurgitation (TR), and right ventricular function were documented. Exploratory hypotheses were tested with chi-square and t tests. Stepwise logistic regression was used to identify any multiple sets of relatively independent variables.
Thirty patients met inclusion criteria. Fourteen patients underwent 22 different interventions at the atrial septum, ductus arteriosus, or retro-aortic arch in the IS period. Baseline ASD gradient (P = .012) and ductus arteriosus velocity (P = .002) predicted an IS intervention. There were significant differences in LPA and RPA VTI (P = .011, .03), p1/2 (P = .038, .008), and S/D (P = .012, .033); RPA slope (P = .013); ASD gradient (P = .003); ductus arteriosus velocity (P = .021); and TR (P = .031) before and after an intervention. There were significant differences in post-hybrid versus pre-comprehensive stage II LPA and RPA VTI (P = .009, .022), PI (P = .031, .022), and peak velocity (P = .004, .037); RPA S/D (P = .025) and p1/2 (P = .029); ductus arteriosus velocity (P < .001); retro-aortic arch peak velocity (P = .035); and ASD mean gradient (P < .001). Pre-comprehensive stage II function tended to predict death (P = .085).
Echocardiographic parameters help predict IS course and guide clinical therapy for this patient population.
对于左心发育不全综合征患者，杂交手术是初始姑息治疗的一种替代方法。目前尚无关于过渡期（IS）的超声心动图数据。本研究的目的是描述这一时期的超声心动图变化。
对诊断为左心发育不全综合征并接受杂交姑息治疗后出院的患者进行病历回顾。回顾了出院时（杂交术后）、任何IS干预前后以及全面二期手术前的超声心动图。记录右肺动脉远端（RPA）和左肺动脉（LPA）的速度、斜率、速度时间积分（VTI）、压力半衰期（p1/2）、搏动指数（PI）以及波形的收缩/舒张（S/D）比值。记录房间隔缺损（ASD）平均压差、动脉导管峰值速度、主动脉弓后峰值速度、三尖瓣反流（TR）和右心室功能。采用卡方检验和t检验对探索性假设进行检验。使用逐步逻辑回归来识别任何多组相对独立的变量。
30例患者符合纳入标准。14例患者在IS期在房间隔、动脉导管或主动脉弓后接受了22种不同的干预。基线ASD压差（P = 0.012）和动脉导管速度（P = 0.002）可预测IS期干预。干预前后LPA和RPA的VTI（P = 0.011，0.03）、p1/2（P = 0.038，0.008）和S/D（P = 0.012，0.033）；RPA斜率（P = 0.013）；ASD压差（P = 0.003）；动脉导管速度（P = 0.021）；以及TR（P = 0.031）存在显著差异。杂交术后与全面二期手术前LPA和RPA的VTI（P = 0.009，0.022）、PI（P = 0.031，0.022）和峰值速度（P = 0.004，0.037）；RPA的S/D（P = 0.025）和p1/2（P = 0.029）；动脉导管速度（P < 0.001）；主动脉弓后峰值速度（P = 0.035）；以及ASD平均压差（P < 0.001）存在显著差异。全面二期手术前的功能倾向于预测死亡（P = 0.085）。
超声心动图参数有助于预测IS期病程并指导该患者群体的临床治疗。
