Mi Yaping, Rädle-Hurst Tanja, Rentzsch Axel, Aicher Diana, Schäfers Hans Joachim, Abdul-Khaliq Hashim
Department of Pediatric Cardiology, Saarland University Hospital, 66421 Homburg Saar, Germany.
Pediatr Cardiol. 2013 Jan;34(1):30-8. doi: 10.1007/s00246-012-0376-7. Epub 2012 Jun 2.
We aimed to evaluate the outcome and regional and global left-ventricular (LV) function after aortic valve repair in children with congenital aortic valve disease. Thirty-two consecutive patients with a mean age of 12.62 years (4 months to 18 years) undergoing aortic valve repair due to valve stenosis (AS group, n = 21) or aortic regurgitation (AR group, n = 11) were studied during a follow-up period of 12 months regarding change and adaptation of myocardial function using conventional and novel echocardiographic methods, including two-dimensional (2D) strain echocardiogram. Conventional and 2D strain echocardiographic studies were performed and analyzed off-line using commercially available software (EchoPac 6.1.0, GE). Peak aortic valve gradient decreased from 62.04 ± 30.34 mmHg before surgery to 22.80 ± 14.13 mmHg 2 weeks after surgery and to 35.73 ± 22.11 mmHg 12 months after surgery (p = 0.01). The degree of AR decreased significantly to grade 0 in 20 children and to grade I in 12. There was a significant decrease of thickness of the interventricular septum (IVS) and posterior wall resulting in improvement of LV mass index (p = 0.007, p = 0.043, and p = 0.001, respectively). Significant decrease of myocardial thickness was found, especially in the IVS, in the AS group (p = 0.008), and a significant decrease in LV end-diastolic dimension (EDD) was found in the AR group (p = 0.007). 2D strain analysis showed that global peak strain, global systolic strain rate, and global early diastolic strain rates improved significantly for all patients during the study period after aortic valve repair (p < 0.001, p = 0.037, and p = 0.018, respectively). The global strain and strain rates correlated significantly to IVS thickness (r = 0.002 and r = 0.003, respectively), LV mass index (r = 0.02 and r = 0.015, respectively), and EDD (r = 0.26 and r = 0.005, respectively). Aortic valve repair surgery in pediatric patients results in improvement of global and regional systolic and diastolic LV parameters, which was better shown by 2D strain parameters rather than conventional echocardiographic parameters.
我们旨在评估先天性主动脉瓣疾病患儿行主动脉瓣修复术后的结局以及左心室（LV）局部和整体功能。对32例连续接受主动脉瓣修复术的患儿进行了研究，这些患儿的平均年龄为12.62岁（4个月至18岁），其中因瓣膜狭窄（AS组，n = 21）或主动脉瓣反流（AR组，n = 11）接受手术。在12个月的随访期内，使用传统和新型超声心动图方法，包括二维（2D）应变超声心动图，研究心肌功能的变化和适应性。使用市售软件（EchoPac 6.1.0，GE）对传统和2D应变超声心动图研究进行离线分析。主动脉瓣峰值梯度从术前的62.04±30.34 mmHg降至术后2周的22.80±14.13 mmHg以及术后12个月的35.73±22.11 mmHg（p = 0.01）。12例患儿的主动脉瓣反流程度显著降低至I级，20例患儿降至0级。室间隔（IVS）和后壁厚度显著降低，导致左心室质量指数改善（分别为p = 0.007、p = 0.043和p = 0.001）。AS组心肌厚度显著降低，尤其是IVS（p = 0.008），AR组左心室舒张末期内径（EDD）显著降低（p = 0.007）。2D应变分析显示，在主动脉瓣修复术后的研究期间，所有患者的整体峰值应变、整体收缩期应变率和整体早期舒张期应变率均显著改善（分别为p < 0.001、p = 0.037和p = 0.018）。整体应变和应变率与IVS厚度（分别为r = 0.002和r = 0.003）、左心室质量指数（分别为r = 0.02和r = 0.015）以及EDD（分别为r = 0.26和r = 0.005）显著相关。小儿患者的主动脉瓣修复手术可改善左心室整体和局部的收缩及舒张参数，2D应变参数比传统超声心动图参数能更好地显示这一点。
