先天性左心发育不全综合征患儿在 Norwood 手术后右心功能和纵向应变的变化。
Changes of right ventricular function and longitudinal deformation in children with hypoplastic left heart syndrome before and after the Norwood operation.
机构信息
Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
出版信息
J Am Soc Echocardiogr. 2011 Nov;24(11):1226-32. doi: 10.1016/j.echo.2011.08.016. Epub 2011 Sep 29.
BACKGROUND
The purpose of this study was to investigate changes in right ventricular (RV) function and deformation parameters before and at steady state after the Norwood operation in neonates with hypoplastic left heart syndrome. A further aim was to delineate factors that affected these changes.
METHODS
On echocardiograms before and 21 days (range, 10-35 days) after the Norwood operation, the two-dimensional speckle-tracking parameters global and regional peak systolic longitudinal strain and strain rate were retrospectively compared in 33 patients with hypoplastic left heart syndrome. In addition, RV functional assessment included RV fractional area change and tricuspid annular plane systolic excursion. The associations between postoperative echocardiographic findings and preoperative or postoperative complications, prenatal diagnosis, postoperative heart rate, oxygen saturation, and medication use as well as cardiopulmonary bypass and aortic cross-clamp times were tested.
RESULTS
Global strain (-18.3 ± 3.6% vs -16.8 ± 3.8%, P = .02) and global strain rate (-1.6 ± 0.3 vs -1.2 ± 0.3 sec(-1), P < .0001) decreased significantly. Regional strain decreased significantly in the apical and mid lateral segments, while regional strain rate decreased significantly in all but the basal septal segments. Tricuspid annular plane systolic excursion of the lateral annulus decreased significantly, while RV fractional area change remained the same. No significant associations were found between postoperative RV function and potential impact factors.
CONCLUSIONS
Two-dimensional global and regional longitudinal strain and strain rate as well as tricuspid annular plane systolic excursion were reduced in patients with hypoplastic left heart syndrome after the Norwood operation. None of the examined preoperative and postoperative patient or surgical factors was found to explain this decrease.
背景
本研究旨在探讨左心发育不全综合征新生儿行 Norwood 手术后右心室（RV）功能和变形参数的变化，并探讨影响这些变化的因素。
方法
回顾性比较 33 例左心发育不全综合征患儿 Norwood 手术后及术后 21 天（范围 10-35 天）的二维斑点追踪参数整体和节段峰值收缩期纵向应变和应变率。此外，RV 功能评估包括 RV 局部射血分数和三尖瓣环平面收缩期位移。检测术后超声心动图发现与术前或术后并发症、产前诊断、术后心率、氧饱和度、药物使用以及体外循环和主动脉阻断时间之间的相关性。
结果
整体应变（-18.3±3.6%比-16.8±3.8%，P=0.02）和整体应变率（-1.6±0.3 比-1.2±0.3 秒（-1），P<0.0001）显著降低。心尖和侧壁节段的局部应变显著降低，而除基底间隔段外，所有节段的局部应变率均显著降低。外侧环三尖瓣环平面收缩期位移显著降低，而 RV 局部射血分数保持不变。术后 RV 功能与潜在影响因素之间无显著相关性。
结论
左心发育不全综合征患儿行 Norwood 手术后二维整体和节段纵向应变和应变率以及三尖瓣环平面收缩期位移均降低。未发现术前和术后任何患者或手术因素可解释这种下降。
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