Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
J Am Soc Echocardiogr. 2012 Nov;25(11):1222-30. doi: 10.1016/j.echo.2012.08.005. Epub 2012 Sep 11.
Differences in single right ventricle (SRV) and single left ventricles (SLV) function are poorly described, although myocardial dysfunction is an important risk factor for morbidity and mortality. The aims of this study were to compare function between patients with SRVs and those with SLVs using newer echocardiographic techniques and to determine differences across staged palliation.
In this cross-sectional study comparing 30 patients with SRVs and 30 with SLVs of similar ages (2.5 ± 1.7 vs 2.6 ± 1.6 years), patients were matched for surgical stage (20 pre-bidirectional cavopulmonary anastomosis, 20 pre-Fontan, and 20 post-Fontan patients). Circumferential and longitudinal strain, strain rate (SR), early diastolic SR, postsystolic strain index, and myocardial dyssynchrony index were measured. Comparisons between SRV and SLV parameters were made as a whole group and by subanalysis at each surgical stage.
Patients with SRVs had reduced systolic SRs (circumferential: -1.0%/sec vs -1.2%/sec, P = .01; longitudinal: -1.1%/sec vs -1.3%/sec, P = .002), reduced early diastolic SRs (circumferential: 1.4%/sec vs 1.9%/sec, P = .03; longitudinal: 1.6%/sec vs 2.2%/sec, P = .001), and increased circumferential postsystolic strain indexes (8% vs 0%, P < .0001). Subanalysis at each surgical stage showed that the greatest disparity in systolic parameters occurred before bidirectional cavopulmonary anastomosis (longitudinal SR, P = .009; postsystolic strain index, P = .005) and that parity was regained after the Fontan procedure, while traditional diastolic parameters (E velocity, P = .004; E/E' ratio, P = .0003) were reduced in patients with SRVs after the Fontan procedure.
The SRV has reduced contractility and diastolic function compared with the SLV. Ventricular systolic performance in patients with SRVs was poorest before bidirectional cavopulmonary anastomosis, while differences in diastolic function were more prominent after Fontan completion.
尽管心肌功能障碍是发病率和死亡率的重要危险因素，但单右心室（SRV）和单左心室（SLV）功能的差异描述甚少。本研究的目的是使用更新的超声心动图技术比较 SRV 患者和 SLV 患者的功能，并确定在不同分期姑息治疗中的差异。
在这项比较 30 例 SRV 患者和 30 例年龄相似的 SLV 患者（2.5 ± 1.7 岁对 2.6 ± 1.6 岁）的横断面研究中，根据手术阶段对患者进行匹配（20 例双向腔静脉肺动脉吻合术前，20 例 Fontan 术前，20 例 Fontan 术后）。测量圆周应变、纵向应变、应变率（SR）、早期舒张期 SR、收缩后应变指数和心肌不同步指数。对整个组和每个手术阶段的亚组分析进行了 SRV 和 SLV 参数之间的比较。
SRV 患者的收缩期 SR 降低（圆周：-1.0%/sec 对-1.2%/sec，P =.01；纵向：-1.1%/sec 对-1.3%/sec，P =.002），早期舒张期 SR 降低（圆周：1.4%/sec 对 1.9%/sec，P =.03；纵向：1.6%/sec 对 2.2%/sec，P =.001），圆周收缩后应变指数增加（8%对 0%，P <.0001）。每个手术阶段的亚组分析显示，在双向腔静脉肺动脉吻合术之前，收缩参数的差异最大（纵向 SR，P =.009；收缩后应变指数，P =.005），在 Fontan 手术后恢复了一致性，而传统的舒张参数（E 速度，P =.004；E/E' 比值，P =.0003）在 Fontan 手术后在 SRV 患者中降低。
与 SLV 相比，SRV 的收缩性和舒张功能降低。在双向腔静脉肺动脉吻合术之前，SRV 患者的心室收缩性能最差，而在 Fontan 完成后，舒张功能的差异更为明显。
