Banka Puja, Schaetzle Barbara, Komarlu Rukmini, Emani Sitaram, Geva Tal, Powell Andrew J
Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
J Cardiovasc Magn Reson. 2014 Oct 7;16(1):73. doi: 10.1186/s12968-014-0073-1.
We sought to identify cardiovascular magnetic resonance (CMR) parameters associated with successful univentricular to biventricular conversion in patients with small left hearts.
Patients with small left heart structures and a univentricular circulation who underwent CMR prior to biventricular conversion were retrospectively identified and divided into 2 anatomic groups: 1) borderline hypoplastic left heart structures (BHLHS), and 2) right-dominant atrioventricular canal (RDAVC). The primary outcome variable was transplant-free survival with a biventricular circulation.
In the BHLHS group (n = 22), 16 patients (73%) survived with a biventricular circulation over a median follow-up of 40 months (4-84). Survival was associated with a larger CMR left ventricular (LV) end-diastolic volume (EDV) (p = 0.001), higher LV-to-right ventricle (RV) stroke volume ratio (p < 0.001), and higher mitral-to-tricuspid inflow ratio (p = 0.04). For predicting biventricular survival, the addition of CMR threshold values to echocardiographic LV EDV improved sensitivity from 75% to 93% while maintaining specificity at 100%. In the RDAVC group (n = 10), 9 patients (90%) survived with a biventricular circulation over a median follow-up of 29 months (3-51). The minimum CMR values were a LV EDV of 22 ml/m² and a LV-to-RV stroke volume ratio of 0.19.
In BHLHS patients, a larger LV EDV, LV-to-RV stroke volume ratio, and mitral-to-tricuspid inflow ratio were associated with successful biventricular conversion. The addition of CMR parameters to echocardiographic measurements improved the sensitivity for predicting successful conversion. In RDAVC patients, the high success rate precluded discriminant analysis, but a range of CMR parameters permitting biventricular conversion were identified.
我们试图确定与左心较小的患者单心室成功转为双心室相关的心血管磁共振（CMR）参数。
回顾性纳入左心结构较小且单心室循环、在双心室转换前接受CMR检查的患者，并将其分为2个解剖学组：1）临界左心发育不全结构（BHLHS），2）右优势型房室管（RDAVC）。主要结局变量是双心室循环下无移植生存。
在BHLHS组（n = 22）中，16例患者（73%）在中位随访40个月（4 - 84个月）时双心室循环存活。生存与CMR左心室（LV）舒张末期容积（EDV）较大（p = 0.001）、左心室与右心室（RV）每搏量比值较高（p < 0.001）以及二尖瓣与三尖瓣流入比值较高（p = 0.04）相关。为预测双心室生存，在超声心动图LV EDV基础上增加CMR阈值可将敏感性从75%提高至93%，同时特异性维持在100%。在RDAVC组（n = 10）中，9例患者（90%）在中位随访29个月（3 - 51个月）时双心室循环存活。CMR最小值为LV EDV 22 ml/m²和LV与RV每搏量比值0.19。
在BHLHS患者中，较大的LV EDV、LV与RV每搏量比值以及二尖瓣与三尖瓣流入比值与双心室转换成功相关。在超声心动图测量中增加CMR参数可提高预测成功转换的敏感性。在RDAVC患者中，高成功率使判别分析无法进行，但确定了一系列允许双心室转换的CMR参数。
