Bharucha Tara, Fernandes Fernanda, Slorach Cameron, Mertens Luc, Friedberg Mark Kevin
The Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
Echocardiography. 2012 Apr;29(4):484-91. doi: 10.1111/j.1540-8175.2011.01595.x. Epub 2011 Dec 9.
Pressure gradient is used for timing of balloon aortic valvuloplasty for aortic stenosis (AS) in children, but does not correlate well with outcome and is limited if ventricular function is poor. In adults, effective orifice area (EOA) is used to assess AS severity, but EOA by continuity equation or 2D echo is unreliable in children. Three-dimensional echocardiography (3DE) may reliably assess EOA but has not been studied in children. We assessed measurement of aortic valve EOA by 3DE in children with AS before and after balloon aortic valvuloplasty and compared results with change in aortic valve gradient.
3DE was performed at time of catheterization before and after balloon aortic valvuloplasty. Using 3DE multiplanar review mode, valve annulus diameter, area, and EOA were measured and compared with change in aortic gradient and degree of aortic insufficiency.
Twenty-four 3DE studies in 12 children (mean age 4.4 ± 5.0 years) were analyzed. EOA was measurable in all. Catheter peak gradient decreased from 45 ± 10 to 26 ± 17 mmHg (P = 0.0018). 3DE EOA increased after balloon aortic valvuloplasty (0.59 ± 0.52 cm(2) vs 0.80 ± 0.70 cm(2) ; P = 0.03), without change in valve diameter. EOA change correlated with change in peak (r = 0.77; P = 0.005) and mean (r = 0.60; P = 0.03) aortic valve gradient post balloon aortic valvuloplasty.
3DE facilitates EOA measurement in pediatric AS and correlates with change in aortic valve gradient after balloon valvuloplasty.
压力梯度用于确定儿童主动脉瓣狭窄（AS）球囊主动脉瓣成形术的时机，但与预后相关性不佳，且在心室功能较差时其作用有限。在成人中，有效瓣口面积（EOA）用于评估AS严重程度，但通过连续方程或二维超声心动图测量的EOA在儿童中并不可靠。三维超声心动图（3DE）可能可靠地评估EOA，但尚未在儿童中进行研究。我们评估了3DE在儿童AS球囊主动脉瓣成形术前后对主动脉瓣EOA的测量，并将结果与主动脉瓣压力梯度变化进行比较。
在球囊主动脉瓣成形术前后的导管插入术时进行3DE检查。使用3DE多平面回顾模式，测量瓣环直径、面积和EOA，并与主动脉压力梯度变化和主动脉瓣关闭不全程度进行比较。
分析了12名儿童（平均年龄4.4±5.0岁）的24项3DE研究。所有患者的EOA均可测量。导管峰值压力梯度从45±10 mmHg降至26±17 mmHg（P = 0.0018）。球囊主动脉瓣成形术后3DE测量的EOA增加（0.59±0.52 cm²对0.80±0.70 cm²；P = 0.03），瓣膜直径无变化。EOA变化与球囊主动脉瓣成形术后主动脉瓣峰值（r = 0.77；P = 0.005）和平均（r = 0.60；P = 0.03）压力梯度变化相关。
3DE有助于测量儿童AS的EOA，并与球囊瓣膜成形术后主动脉瓣压力梯度变化相关。
