Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
New England Research Institutes, Watertown, Massachusetts.
J Am Soc Echocardiogr. 2017 Jul;30(7):699-707.e1. doi: 10.1016/j.echo.2017.03.005. Epub 2017 May 10.
Infants with single ventricular physiology have volume and pressure overload that adversely affect ventricular mechanics. The impact of superior cavopulmonary anastomosis (SCPA) on single left ventricles versus single right ventricles is not known.
As part of the Pediatric Heart Network placebo-controlled trial of enalapril in infants with single ventricular physiology, echocardiograms were obtained before SCPA and at 14 months and analyzed in a core laboratory. Retrospective analysis of the following measurements included single ventricular end-diastolic volume (EDV), end-systolic volume (ESV), mass, mass-to-volume ratio (mass/volume), and ejection fraction. Qualitative assessment of atrioventricular valve regurgitation and assessment of diastolic function were also performed.
A total of 156 participants underwent echocardiography at both time points. Before SCPA, mean ESV and mass Z scores were elevated (3.4 ± 3.7 and 4.2 ± 2.9, respectively) as were mean EDV and mass/volume Z scores (2.1 ± 2.5 and 2.0 ± 2.9, respectively). EDV, ESV, and mass decreased after SCPA, but mass/volume and the degree of atrioventricular valve regurgitation did not change. Subjects with morphologic left ventricles demonstrated greater reductions in ventricular volumes and mass than those with right ventricles (mean change in Z score: left ventricular [LV] EDV, -1.9 ± 2.1; right ventricular EDV, -0.7 ± 2.5; LV ESV, -2.3 ± 2.9; right ventricular ESV, -0.9 ± 4.6; LV mass, -2.5 ± 2.8; right ventricular mass, -1.3 ± 2.6; P ≤ .03 for all). Approximately one third of patients whose diastolic function could be assessed had abnormalities at each time point.
Decreases in ventricular size and mass occur in patients with single ventricle after SCPA, and the effect is greater in those with LV morphology. The remodeling process resulted in commensurate changes in ventricular mass and volume such that the mass/volume did not change significantly in response to the volume-unloading surgery.
单心室生理的婴儿存在容量和压力超负荷，这会对心室力学产生不利影响。尚不清楚 Superior cavopulmonary anastomosis（SCPA）对单左心室与单右心室的影响。
作为儿科心脏网络中依那普利治疗单心室生理婴儿安慰剂对照试验的一部分，在 SCPA 前和 14 个月时获取超声心动图，并在核心实验室进行分析。对以下测量值进行回顾性分析，包括单心室舒张末期容积（EDV）、收缩末期容积（ESV）、质量、质量与容积比（mass/volume）和射血分数。还进行了房室瓣反流的定性评估和舒张功能评估。
共有 156 名参与者在两个时间点均进行了超声心动图检查。在 SCPA 之前，平均 ESV 和质量 Z 评分升高（分别为 3.4±3.7 和 4.2±2.9），平均 EDV 和质量/容积 Z 评分也升高（分别为 2.1±2.5 和 2.0±2.9）。SCPA 后 EDV、ESV 和质量降低，但 mass/volume 和房室瓣反流程度没有变化。形态学左心室的患者比右心室患者的心室容积和质量降低更大（平均 Z 评分变化：左心室 EDV，-1.9±2.1；右心室 EDV，-0.7±2.5；左心室 ESV，-2.3±2.9；右心室 ESV，-0.9±4.6；左心室质量，-2.5±2.8；右心室质量，-1.3±2.6；P≤0.03 所有）。大约三分之一可以评估舒张功能的患者在每个时间点都存在异常。
SCPA 后单心室患者的心室大小和质量减小，LV 形态患者的效果更大。重塑过程导致心室质量和体积的相应变化，因此心室质量/容积在容量减负荷手术后没有显著变化。
