Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Int J Cardiol. 2012 Sep 20;160(1):59-65. doi: 10.1016/j.ijcard.2011.03.031. Epub 2011 Apr 7.
The relation between pulmonary venous flow (PVF) pattern and degree of left-to-right interatrial shunting (IAS) in patients with secundum atrial septal defect (ASD) is unknown.
Fifty consecutive ASD patients (14 males, 36 ± 17 years) received transthoracic echocardiography (TTE) before and 1 day after transcatheter closure and their results were compared to 40 controls. The ratio of pulmonary-to-systemic flows (Qp/Qs) was assessed by TTE and invasive oximetry.
Pre-closure PV systolic (PVs), diastolic (PVd) velocities and velocity-time integral (PV-VTI) increased, time from onset of ECG Q-wave to the peak PV diastolic wave (Q-PVd) shortened and atrial reversal (PVar) velocity significantly decreased as compared to normals. These findings normalized after closure. Patients with large IAS (defined as invasive Qp/Qs ≥ 2) had higher PVs, PVd and PV-VTI, shorter Q-PVd but lower PVar (all p<0.01) than those with small IAS. Invasive Qp/Qs ratios correlated with PVs, PVd, PV-VTI, Q-PVd and TTE-derived Qp/Qs ratios, ASD sizes and RV end-diastolic dimensions (all p<0.05). PV-VTI (β=0.49) and ASD size (β=0.48) remained independent predictors of large IAS after multivariate analysis. The corresponding sensitivity, specificity and AUC were 89%, 82% and 0.90 respectively for a PV-VTI of 30 cm (p<0.001).
ASD patients with significant IAS have distinguishable PVF features. Doppler evaluation of PV-VTI is a novel additional tool for assessing the magnitude of shunting in these patients non-invasively.
在继发孔房间隔缺损（ASD）患者中，肺静脉血流（PVF）模式与左右心房间分流量（IAS）程度之间的关系尚不清楚。
50 例连续 ASD 患者（男 14 例，年龄 36±17 岁）在经导管闭合前后接受了经胸超声心动图（TTE）检查，并与 40 例对照进行了比较。TTE 和有创血氧测定评估肺循环与体循环血流量比（Qp/Qs）。
与正常组相比，ASD 患者在闭合前 PV 收缩期（PVs）、舒张期（PVd）速度和速度时间积分（PV-VTI）增加，心电图 Q 波起始至 PV 舒张波峰的时间（Q-PVd）缩短，心房反转（PVar）速度显著降低。这些发现在闭合后恢复正常。IAS 较大（定义为有创 Qp/Qs≥2）的患者的 PVs、PVd 和 PV-VTI 较高，Q-PVd 较短，但 PVar 较低（均 p<0.01）。有创 Qp/Qs 比值与 PVs、PVd、PV-VTI、Q-PVd 和 TTE 衍生的 Qp/Qs 比值、ASD 大小和 RV 舒张末期直径相关（均 p<0.05）。多元分析后，PV-VTI（β=0.49）和 ASD 大小（β=0.48）仍然是 IAS 较大的独立预测因素。PV-VTI 为 30cm 时的敏感性、特异性和 AUC 分别为 89%、82%和 0.90（p<0.001）。
IAS 明显的 ASD 患者具有可区分的 PVF 特征。PV-VTI 的多普勒评估是一种新的无创工具，可用于评估这些患者的分流量大小。
