Palii Ina
Departamentul Cardiologie pediatrică, Institutul de Cercetări Stiinţifice în Domeniul Ocrotirii Sănătăţii Mamei si Copilului.
Rev Med Chir Soc Med Nat Iasi. 2012 Jan-Mar;116(1):114-21.
The aim of this study was the determination of the particularities of the cardiac remodeling with echo-cardio graphic methods at patients with chronic heart failure (CHF) secondary to congenital heart diseases and pulmonary arterial hypertension (PAH).
In the study 204 children were included (average age of 37.1 +/- 3.7 months) with CHF secondary to congenital systemic-to-pulmonary shunts (simple, combined and complex) associated with PAH. Depending on the rang of PAH the children were divided into 2 subgroups: IA--59 patients with CHF and moderate PAH and IB--145 children with CHF and severe PAH. Using the echocardiography 2D the right and left dimensions of the heart, EF, SF of LV were determined; the Doppler exam--the global function of RV (Tei performance index), systolic and mean pressure in PA.
The particularities of the cardiac remodeling estimated echocardiography with diagnostic value at patients with CHF secondary to congenital shunts complicated with PAH are the following: dilatation of the right cavities of the heart (RVDd and RAD) and of the PA with the tendency of reduction of the LV dimensions, hypertrophy of the anterior wall of the RV, the increasing of the diameter of the fibrosis ring at tricuspid valve, the global dysfunction of RV (Tei index), valvular insufficiency (TVI and PVI), the diminishing of the cardiac index. These parameters were more significant at patients with severe PAH (p < 0.001), denoting the consequences of the pressure overload on the cardiac remodeling, estimating the level of hemodynamic severity and with certainty can have a special meaning in deciding the therapeutic tactics, prognosis and evolution.
本研究的目的是采用超声心动图方法确定先天性心脏病继发慢性心力衰竭（CHF）和肺动脉高压（PAH）患者心脏重塑的特点。
本研究纳入了204例儿童（平均年龄37.1±3.7个月），他们患有先天性体肺分流（简单、联合和复杂）继发的CHF并伴有PAH。根据PAH的程度，将儿童分为2个亚组：IA组——59例CHF合并中度PAH患者，IB组——145例CHF合并重度PAH儿童。使用二维超声心动图测定心脏的左右径、左心室射血分数（EF）、短轴缩短率（SF）；进行多普勒检查——右心室整体功能（Tei指数）、肺动脉收缩压和平均压。
对于先天性分流继发CHF并合并PAH的患者，超声心动图评估具有诊断价值的心脏重塑特点如下：右心腔（右心室舒张末期内径和右心房内径）和肺动脉扩张，左心室尺寸有减小趋势，右心室前壁肥厚，三尖瓣纤维化环直径增加，右心室整体功能障碍（Tei指数），瓣膜关闭不全（三尖瓣反流和肺动脉瓣反流），心脏指数降低。这些参数在重度PAH患者中更显著（p<0.001），表明压力超负荷对心脏重塑的影响，评估血流动力学严重程度，并且在确定治疗策略、预后和病情发展方面肯定具有特殊意义。
