Department of Diagnostic and Interventional Radiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
Clin Res Cardiol. 2012 Dec;101(12):963-71. doi: 10.1007/s00392-012-0485-6. Epub 2012 Jun 20.
Systemic right ventricle (RV) hypertrophy and impaired function occur after atrial switch for dextro-transposition of the great arteries (d-TGA). Echocardiography is limited in its ability to assess the RV. We sought to evaluate systemic RV myocardial-mass index (MMI) and function after atrial switch and to analyse the role of hypertrophy for ventricular function with special consideration of the interventricular septal (IVS) movement.
Thirty-seven consecutive patients (median age 22.9 years) after atrial switch were studied using cardiac magnetic resonance imaging (1.5T Intera, Philips) with a dedicated 5-channel phased-array surface cardiac coil. Cine steady-state free-precession sequences were acquired to obtain myocardial masses and function. The systolic movement of the IVS was defined as positive when moving towards the centroid of the RV and was defined as non-positive otherwise. Patient parameters were compared to controls.
The systemic RVs were significantly larger (p < 0.001) than the left ventricles of the control group, systolic function was significantly impaired (p < 0.001) and MMI including the IVS was comparable (p = n.s.). RV-MMI excluding the IVS and RV ejection fraction (EF) demonstrated a quadratic correlation (r = 0.6, p < 0.001), meaning that patients with RV-MMI ≤29 g/m(2) and >68 g/m(2) had a reduced level of systolic function. Positive septal movement improved RV function compared with non-positive septal movement (p = 0.024).
There seems to be a range of beneficial RV hypertrophy after atrial switch in which a sufficient RV-EF can be expected. A positive septal movement, probably the result of hypertrophic septal RV fibres, improves RV function and might be regarded as a beneficial contraction pattern.
右旋型大动脉转位（d-TGA）患者行心房调转术后会出现系统性右心室（RV）肥厚和功能障碍。超声心动图在评估 RV 方面能力有限。我们旨在评估心房调转术后系统性 RV 心肌质量指数（MMI）和功能，并分析肥厚对心室功能的作用，特别考虑到室间隔（IVS）运动。
使用专用 5 通道相控阵表面心脏线圈对 37 例连续行心房调转术的患者（中位年龄 22.9 岁）进行心脏磁共振成像（1.5T Intera，Philips）检查。获得心肌质量和功能的电影稳态自由进动序列。当 IVS 向 RV 质心移动时，将其收缩运动定义为阳性，否则定义为非阳性。将患者参数与对照组进行比较。
系统性 RV 明显大于对照组的左心室（p<0.001），收缩功能明显受损（p<0.001），包括 IVS 的 MMI 相当（p=n.s.）。不包括 IVS 的 RV-MMI 和 RV 射血分数（EF）呈二次相关（r=0.6，p<0.001），这意味着 RV-MMI≤29 g/m2 和>68 g/m2 的患者收缩功能降低。阳性 IVS 运动与非阳性 IVS 运动相比改善 RV 功能（p=0.024）。
心房调转术后似乎存在 RV 适度肥厚的范围，在此范围内可预期 RV-EF 处于足够水平。阳性 IVS 运动，可能是 RV 肥厚室间隔纤维的结果，可改善 RV 功能，可视为有益的收缩模式。
