Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
University of Nebraska College of Medicine/Children's Hospital and Medical Center, Omaha, Nebraska.
J Am Soc Echocardiogr. 2017 May;30(5):468-477. doi: 10.1016/j.echo.2017.01.001. Epub 2017 Mar 3.
Single right ventricles (SRV) are postulated to be disadvantaged compared with single left ventricles (SLV). We compared the evolution of SRV versus SLV function during infancy using conventional measures and speckle-tracking echocardiography (STE). We hypothesized that the SRV is mechanically disadvantaged during early infancy.
SRVs (n = 32) were compared with SLVs (n = 16) at the neonatal (presurgery) and pre-bidirectional cavopulmonary anastomosis (pre-BCPA) stages. Functional measures (fractional area change, indexed ventricular annular plane systolic excursion [iVAPSE], isovolumic acceleration [IVA], myocardial performance index, E and A velocities, tissue Doppler imaging annular velocities and STE-measured global longitudinal and circumferential strain, strain rate [SR], and early diastolic SR [EDSR]) were compared between SRV and SLV at each stage and between presurgery and pre-BCPA.
Compared with SLV, presurgery SRV had lower circumferential strain (-10.6% vs -16.5%; P = .0002) and EDSR (1.41%/sec vs 2.13%/sec; P = .001). Pre-BCPA SRV had decreased IVA (1.2 vs 2.1 m/sec; P = .006): longitudinal strain (-15.3% vs -19.1%; P = .001), SR (-0.97%/sec vs -1.53%/sec; P = .0001), EDSR (1.5%/sec vs 2.1%/sec; P = .001); circumferential strain (-10.6% vs -14.9%; P = .002), SR (-0.8%/sec vs -1.21%/sec; P = .0001), and EDSR (1.3%/sec vs 1.8%/sec; P = .009). SRV showed reduction of iVAPSE, IVA, s', e', a' velocities, longitudinal strain, SR, EDSR, and circumferential SR (P < .05) from presurgery to pre-BCPA, while circumferential strain was unchanged. SLV showed no significant change in these parameters during this interval.
The progressive reduction in SRV longitudinal and circumferential function suggests that SRV may have a mechanical disadvantage from birth and progressive impairment with age.
单右心室（SRV）被认为比单左心室（SLV）处于劣势。我们使用传统测量方法和斑点追踪超声心动图（STE）比较了婴儿期 SRV 与 SLV 功能的演变。我们假设在婴儿早期，SRV 在机械上处于劣势。
在新生儿（术前）和双向腔静脉肺动脉吻合术（pre-BCPA）前阶段，将 32 例 SRV 与 16 例 SLV 进行比较。比较了 SRV 和 SLV 在各阶段的功能指标（面积变化分数、指数化室间隔环平面收缩期位移[iVAPSE]、等容加速度[IVA]、心肌运动指数、E 和 A 速度、组织多普勒成像环速度和 STE 测量的整体纵向和圆周应变、应变率[SR]和舒张早期 SR[EDSR]），以及术前和 pre-BCPA 之间的比较。
与 SLV 相比，术前 SRV 的圆周应变（-10.6% vs -16.5%；P=0.0002）和 EDSR（1.41%/sec vs 2.13%/sec；P=0.001）较低。pre-BCPA SRV 的 IVA 降低（1.2 对 2.1m/sec；P=0.006）：纵向应变（-15.3% vs -19.1%；P=0.001）、SR（-0.97%/sec vs -1.53%/sec；P=0.0001）、EDSR（1.5%/sec vs 2.1%/sec；P=0.001）；圆周应变（-10.6% vs -14.9%；P=0.002）、SR（-0.8%/sec vs -1.21%/sec；P=0.0001）和 EDSR（1.3%/sec vs 1.8%/sec；P=0.009）。SRV 从术前到 pre-BCPA 时，iVAPSE、IVA、s'、e'、a' 速度、纵向应变、SR、EDSR 和圆周 SR 均降低（P<0.05），而圆周应变无明显变化。在此期间，SLV 这些参数没有明显变化。
SRV 纵向和圆周功能的逐渐降低表明，SRV 可能从出生时就具有机械劣势，并随着年龄的增长而逐渐受损。
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