De Caro Enrico, Bondanza Sara, Calevo Maria Grazia, Trocchio Gianluca, Lupi Gabriele, Domenicucci Stefano, Marasini Maurizio
Department of Cardiology, Istituto Giannina Gaslini, Genoa, Italy.
Congenit Heart Dis. 2014 May-Jun;9(3):252-8. doi: 10.1111/chd.12135. Epub 2013 Sep 8.
In adult patients with d-transposition of the great arteries after atrial switch operation, dysfunction of the systemic right ventricle (RV) is a well-known complication. Echocardiographic variables may provide adequate estimation of subpulmonary RV function, but their applicability to the subaortic RV is not straightforward. We evaluate the concordance between tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging-derived ejection fraction of the RV (MRI-RVEF) in these patients.
Patients were recruited from those evaluated at the adult congenital clinic of our department between 2010 and 2012. All patients who had an echocardiographic assessment within 6 months of their MRI examination were selected. Patients clinically unstable, not in sinus rhythm, with a prosthetic systemic atrioventricular valve, permanent pacemaker, or more than moderate systemic atrioventricular valve regurgitation were excluded.
Eighteen Mustard-operated patients aged 22 ± 3.7 years were studied. The mean values of TAPSE and RVEF were 13.22 ± 1.7 mm and 49.7 ± 6%, respectively. TAPSE and RVEF were normal in 1 (5.5%) and 10 (55.5%) patients, respectively. Seventeen (94.4%) patients showed reduced TAPSE (12.9 ± 1.3 mm): RVEF was reduced in eight (47%) of these subjects, and normal in nine (53%). In patients with normal RVEF, both the MRI-RV end-diastolic and the MRI-RV end-systolic volumes were significantly lower than in patients with reduced RVEF. There were no other statistically significant differences between these patients. No correlation was found between TAPSE and both the MRI-RV end-diastolic and the end-systolic volumes. Globally, agreement between TAPSE and RVEF was slight (K = 0.09 ± 0.089).
Our results indicate that in these patients TAPSE is not a useful measure of RV function.
在接受心房调转手术的成年大动脉d-转位患者中，体循环右心室（RV）功能障碍是一种众所周知的并发症。超声心动图变量可对肺下RV功能进行充分评估，但其对主动脉下RV的适用性并不直接。我们评估了这些患者三尖瓣环平面收缩期位移（TAPSE）与磁共振成像得出的RV射血分数（MRI-RVEF）之间的一致性。
从2010年至2012年在我们科室成人先天性心脏病门诊接受评估的患者中招募患者。选择在MRI检查后6个月内进行过超声心动图评估的所有患者。排除临床不稳定、非窦性心律、有人工体循环房室瓣、永久性起搏器或有中度以上体循环房室瓣反流的患者。
对18例年龄为22±3.7岁、接受Mustard手术的患者进行了研究。TAPSE和RVEF的平均值分别为13.22±1.7mm和49.7±6%。分别有1例（5.5%）和10例（55.5%）患者的TAPSE和RVEF正常。17例（94.4%）患者的TAPSE降低（12.9±1.3mm）：其中8例（47%）患者的RVEF降低，9例（53%）患者的RVEF正常。RVEF正常的患者，MRI-RV舒张末期容积和MRI-RV收缩末期容积均显著低于RVEF降低的患者。这些患者之间无其他统计学显著差异。未发现TAPSE与MRI-RV舒张末期容积和收缩末期容积之间存在相关性。总体而言，TAPSE与RVEF之间的一致性较差（K=0.09±0.089）。
我们的结果表明，在这些患者中，TAPSE不是评估RV功能的有用指标。
