Chen Jiao, Xie Liang, Dai Li, Yu Li, Liu Lijun, Zhou Yongbi, Wu Guiying, Qin Fengfei, Liu Hanmin
Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Pediatr Cardiol. 2016 Dec;37(8):1488-1497. doi: 10.1007/s00246-016-1462-z. Epub 2016 Aug 25.
The objective of this study was to detect the effect of a large ventricular septal defect (VSD) on right ventricular function before and after birth. All consecutive children with large VSD who were born in our hospital between January 2013-February 2016 and followed up throughout early infancy, and who lacked malformations or chromosomal abnormalities, were identified by a retrospective review of the medical records and included in this retrospective longitudinal case-control study (n = 30). Thirty normal control cases with an equivalent gestational age and gender served as controls. Tricuspid annular plane systolic excursion (TAPSE), right ventricle (RV) Tei index, and tricuspid E/E were measured in the fetal, neonatal (day 1-28), and infant (day 29-70) periods. In all periods, the VSD and control groups did not differ in TAPSE values, but VSD associated with higher Tei indices and tricuspid E/E values (in the fetal period: VSD group RV Tei was 0.48 ± 0.12 and E/E was 11.84 ± 1.53, control group RV Tei was 0.42 ± 0.16 and E/E was 10.16 ± 1.61; in neonatal period: VSD group RV Tei was 0.41 ± 0.17 and E/E was 12.21 ± 1.59, control group RV Tei was 0.30 ± 0.13 and E/E was 7.20 ± 1.28; in the infant period: VSD group RV Tei was 0.39 ± 0.09 and E/E was 11.89 ± 2.80, control group RV Tei was 0.28 ± 0.12 and E/E was 5.26 ± 1.90, all p < 0.05). In the fetal and neonatal periods, TAPSE correlated negatively with Tei index and tricuspid E/E in both groups. However, in the infant period, only the control group exhibited correlations between TAPSE and Tei index or tricuspid E/E . Tei index correlated positively with tricuspid E/E in both groups in all three periods. The VSD group had smaller correlation coefficients than the control group. Large VSD may already start to impair RV diastolic and global function before birth. This impairment continued and increased after birth. These changes did not associate with obvious RV longitudinal systolic function impairment. Large VSD mainly affected RV function by decreasing diastolic function and myocardial performance.
本研究的目的是检测大型室间隔缺损（VSD）在出生前后对右心室功能的影响。通过回顾病历，确定了2013年1月至2016年2月在我院出生并在婴儿早期进行随访的所有连续大型VSD患儿，这些患儿无畸形或染色体异常，并纳入了这项回顾性纵向病例对照研究（n = 30）。30例孕周和性别匹配的正常对照病例作为对照组。在胎儿期、新生儿期（第1 - 28天）和婴儿期（第29 - 70天）测量三尖瓣环平面收缩期位移（TAPSE）、右心室（RV）Tei指数和三尖瓣E/E'。在所有时期，VSD组和对照组的TAPSE值无差异，但VSD组的Tei指数和三尖瓣E/E'值较高（胎儿期：VSD组RV Tei为0.48±0.12，E/E'为11.84±1.53，对照组RV Tei为0.42±0.16，E/E'为10.16±1.61；新生儿期：VSD组RV Tei为0.41±0.17，E/E'为12.21±1.59，对照组RV Tei为0.30±0.13，E/E'为7.20±1.28；婴儿期：VSD组RV Tei为0.39±0.09，E/E'为11.89±2.80，对照组RV Tei为0.28±0.12，E/E'为5.26±1.90，所有p < 0.05）。在胎儿期和新生儿期，两组中TAPSE均与Tei指数和三尖瓣E/E'呈负相关。然而，在婴儿期，只有对照组的TAPSE与Tei指数或三尖瓣E/E'之间存在相关性。在所有三个时期，两组中Tei指数均与三尖瓣E/E'呈正相关。VSD组的相关系数低于对照组。大型VSD可能在出生前就已开始损害右心室舒张功能和整体功能。这种损害在出生后持续并加重。这些变化与明显的右心室纵向收缩功能损害无关。大型VSD主要通过降低舒张功能和心肌性能来影响右心室功能。
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