Malakan Rad Elaheh, Ghandi Yazdan, Kocharian Armen, Mirzaaghayan Mohammadreza
Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran .
Amirkabir Hospital, Arak University of Medical Sciences, Arak, Iran.
J Tehran Heart Cent. 2016 Jul 6;11(3):105-110.
The late postoperative course for children with transposition of the great arteries (TGA) with an intact ventricular septum (IVS) is very important because the coronary arteries may be at risk of damage during arterial switch operation (ASO). We sought to investigate left ventricular function in patients with TGA/IVS by echocardiography. From March 2011 to December 2012, totally 20 infants (12 males and 8 females) with TGA/IVS were evaluated via 2-dimensional speckle-tracking echocardiography (2D STE) more than 6 months after they underwent ASO. A control group of age-matched infants and children was also studied. Left ventricular longitudinal strain (S), strain rate (SR), time to peak systolic longitudinal strain (TPS), and time to peak systolic longitudinal strain rate (TPSR) were measured and compared between the 2 groups. Mean ± SD of age at the time of study in the patients with TGA/IVS was 15 ± 5 months, and also age at the time of ASO was 12 ± 3 days. Weight was 3.13 ± 0.07 kg at birth and 8.83 ± 1.57 kg at the time of ASO. Global strain (S), Time to peak strain rate (TPSR), and Time to peak strain (TPS) were not significantly different between the 2 groups, whereas global strain rate (SR) was significantly different (p value < 0.001). In the 3-chamber view, the values of S in the lateral, septal, inferior, and anteroseptal walls were significantly different between the 2 groups (p value < 0.001), and SR in the posterior wall was significantly different between the 2 groups (p value < 0.001). There were no positive correlations between S and SR in terms of the variables of heart rate, total cardiopulmonary bypass time, and aortic cross-clamp time. There were no statistically significant differences between the 2 groups regarding S, SR, TPS, and TPSR in the anteroseptal and posterior walls in the 3-chamber view and in the lateral and septal walls in the 4-chamber view. We showed that between 6 and 18 months after a successful ASO, the parameters of S, SR, and global TPS were normal in our patients with TGA/IVS. However, LV myocardial TPSR did not normalize in this time period.
对于室间隔完整的大动脉转位（TGA）患儿，术后晚期病程非常重要，因为在动脉调转手术（ASO）期间冠状动脉可能有受损风险。我们试图通过超声心动图研究TGA/IVS患者的左心室功能。2011年3月至2012年12月，对20例TGA/IVS患儿（12例男性，8例女性）在接受ASO术后6个月以上进行二维斑点追踪超声心动图（2D STE）评估。还研究了年龄匹配的婴幼儿对照组。测量并比较两组的左心室纵向应变（S）、应变率（SR）、收缩期纵向应变峰值时间（TPS）和收缩期纵向应变率峰值时间（TPSR）。TGA/IVS患者研究时的平均年龄±标准差为15±5个月，ASO时的年龄为12±3天。出生时体重为3.13±0.07 kg，ASO时体重为8.83±1.57 kg。两组之间的整体应变（S）、应变率峰值时间（TPSR）和应变峰值时间（TPS）无显著差异，而整体应变率（SR）有显著差异（p值<0.001）。在三腔视图中，两组之间侧壁、室间隔壁、下壁和前间隔壁的S值有显著差异（p值<0.001），后壁的SR有显著差异（p值<0.001）。就心率、体外循环总时间和主动脉阻断时间变量而言，S与SR之间无正相关。在三腔视图的前间隔壁和后壁以及四腔视图的侧壁和室间隔壁中，两组之间的S、SR、TPS和TPSR无统计学显著差异。我们表明，在成功进行ASO术后6至18个月，我们的TGA/IVS患者的S、SR和整体TPS参数正常。然而，在此时间段左心室心肌TPSR未恢复正常。
