Center of Congenital Heart Disease, Heart and Diabetes Center Northrhine-Westfalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
J Am Soc Echocardiogr. 2009 Oct;22(10):1121-8. doi: 10.1016/j.echo.2009.06.014. Epub 2009 Jul 31.
Congenital heart defects such as coarctation or valvular aortic stenosis are followed by changes in left ventricular myocardial deformation mechanics induced by pressure overload.
Echocardiography was performed in 37 patients (aged 0-27 years, 15 female) with coarctation (27) or valvular aortic stenosis (10) before and after interventional catheterization and compared with 37 body surface area/age-matched healthy children. Deformation was calculated by 2-dimensional strain speckle tracking.
Stress gradients under provocation with orciprenaline in coarctation decreased from 51.8 +/- 20.0 mm Hg to 6.0 +/- 12.0 mm Hg (P < .0001), and resting gradients in aortic stenoses decreased from 57.5 +/- 18.8 mm Hg to 25.5 +/- 14.0 mm Hg (P < .0001) after intervention. Patients had an increased maximal torsion (tor(max): 16.7 +/- 6.7 deg vs 11.0 +/- 4.7 deg (controls; P < .0001), which decreased significantly after therapy (11.8 +/- 4.9 deg, P < .0001).
Compensatory elevation of left ventricular tor(max) in children with moderate left ventricular pressure load changes rapidly after successful interventional treatment. tor(max) may be a valuable tool to assess cardiac unloading or indicate the need for interventional treatment.
先天性心脏病，如缩窄或瓣性主动脉狭窄，会导致左心室心肌变形力学发生压力超负荷诱导的变化。
对 37 例（年龄 0-27 岁，女性 15 例）缩窄（27 例）或瓣性主动脉狭窄（10 例）患者进行介入导管治疗前后的超声心动图检查，并与 37 名体表面积/年龄匹配的健康儿童进行比较。通过二维应变斑点追踪技术计算变形。
缩窄患者在异丙肾上腺素刺激下的压力梯度从 51.8 ± 20.0 mm Hg 降至 6.0 ± 12.0 mm Hg（P <.0001），主动脉狭窄患者的静息梯度从 57.5 ± 18.8 mm Hg 降至 25.5 ± 14.0 mm Hg（P <.0001）。患者的最大扭转（tor(max)）增加（16.7 ± 6.7 度比 11.0 ± 4.7 度（对照组；P <.0001），治疗后显著降低（11.8 ± 4.9 度，P <.0001）。
中度左心室压力负荷变化的儿童左心室 tor(max)代偿性升高，在成功的介入治疗后迅速下降。tor(max)可能是评估心脏卸载或提示介入治疗必要性的有用工具。
