Mivelaz Yvan, Leung Mande T, Zadorsky Mary Terri, De Souza Astrid M, Potts James E, Sandor George G S
Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada.
Am J Cardiol. 2016 Aug 15;118(4):597-602. doi: 10.1016/j.amjcard.2016.05.055. Epub 2016 May 29.
Using noninvasive techniques, we sought to assess arterial stiffness, impedance, hydraulic power, and efficiency in children with postoperative tetralogy of Fallot (TOF), coarctation of the aorta (COA), and transposition of the great arteries (TGAs). Results were compared with those of healthy peers. Fifty-five children with repaired congenital heart disease (24 TOFs, 20 COAs, and 11 TGAs) were compared with 55 age-matched control subjects (CTRL). Echocardiographic Doppler imaging and carotid artery applanation tonometry were preformed to measure aortic flow, dimensions, and calculate pulse wave velocity, vascular impedance and arterial stiffness indexes, hydraulic power (mean and total), and hydraulic efficiency (HE) which were calculated using standard fluid dynamics equations. All congenital heart disease subgroups had higher pulse wave velocity than CTRL. Only the COA group had higher characteristic impedance. Mean power was higher in TGA than in CTRL and TOF, and total power was higher in TGA than in CTRL and TOF. Hydraulic efficiency was higher in TOF than in COA and TGA. In conclusion, children with TOF, COA, and TGA have stiffer aortas than CTRL. These changes may be related to intrinsic aortic abnormalities, altered integrity of the aorta due to surgical repair, and/or acquired postsurgery. These patients may be at increased long-term cardiovascular risk, and long-term follow-up is important for monitoring and assessment of efforts to reduce risk.
我们采用非侵入性技术,试图评估法洛四联症(TOF)、主动脉缩窄(COA)和大动脉转位(TGA)术后患儿的动脉僵硬度、阻抗、水力功率和效率。将结果与健康同龄人的结果进行比较。将55例先天性心脏病修复患儿(24例TOF、20例COA和11例TGA)与55例年龄匹配的对照受试者(CTRL)进行比较。进行超声心动图多普勒成像和颈动脉压平式眼压测量,以测量主动脉血流、尺寸,并计算脉搏波速度、血管阻抗和动脉僵硬度指数、水力功率(平均功率和总功率)以及水力效率(HE),这些参数使用标准流体动力学方程进行计算。所有先天性心脏病亚组的脉搏波速度均高于CTRL组。只有COA组的特征阻抗较高。TGA组的平均功率高于CTRL组和TOF组,总功率高于CTRL组和TOF组。TOF组的水力效率高于COA组和TGA组。总之,TOF、COA和TGA患儿的主动脉比CTRL组更僵硬。这些变化可能与主动脉固有异常、手术修复导致的主动脉完整性改变和/或术后获得性因素有关。这些患者的长期心血管风险可能增加,长期随访对于监测和评估降低风险的措施很重要。