Dittmann H, Jacksch R, Voelker W, Karsch K R, Seipel L
Medical Department III, University of Tuebingen, West Germany.
J Am Coll Cardiol. 1988 Feb;11(2):338-42. doi: 10.1016/0735-1097(88)90099-x.
In previous experimental and pediatric studies, the ratio of pulmonary to systemic flow (Qp/Qs) was accurately estimated by Doppler echocardiography in various cardiac shunt lesions. The purpose of this study was to assess the accuracy of pulsed Doppler echocardiography in determining the magnitude of shunt flow in adult patients with an ostium secundum type atrial septal defect. In 32 patients with high quality echocardiograms and excellent Doppler signals, blood flow was measured in the right and left ventricular outflow tract by Doppler echocardiography. In 16 patients without heart disease, the correlation (r) between systemic (Qs) and pulmonary (Qp) blood flow was 0.96 (SEE = 0.417 liter/min, y = 1.05x - 0.21) and the mean Qp/Qs ratio was 1.01 +/- 0.09. In 16 patients with an atrial septal defect, the Qp/Qs ration measured by oximetry ranged from 1.34 to 4.61 and by pulsed Doppler echocardiography from 1.31 to 4.46 (p = NS). In these 16 patients, the correlation between the Qp/Qs ratio determined by oximetry and pulsed Doppler echocardiography was significant (r = 0.82, SEE = 0.54). In the total group of 32 patients, the correlation was stronger (r = 0.93, SEE = 0.37). Systematic differences between the invasive and noninvasive shunt calculations did not occur. Thus, in adult patients with an atrial septal defect of the secundum type and high quality echocardiograms, the magnitude of left to right shunt can be accurately assessed by pulsed Doppler echocardiography. In the absence of pulmonary hypertension, pulsed Doppler echocardiography provides precise information for the decision to undertake conservative or operative treatment.
在先前的实验和儿科研究中，通过多普勒超声心动图可准确估计各种心脏分流病变中肺循环与体循环血流量之比（Qp/Qs）。本研究的目的是评估脉冲多普勒超声心动图在确定继发孔型房间隔缺损成年患者分流流量大小方面的准确性。对32例拥有高质量超声心动图和极佳多普勒信号的患者，通过多普勒超声心动图测量右心室和左心室流出道的血流。在16例无心脏病的患者中，体循环血流量（Qs）与肺循环血流量（Qp）之间的相关性（r）为0.96（标准误=0.417升/分钟，y = 1.05x - 0.21），平均Qp/Qs比值为1.01±0.09。在16例患有房间隔缺损的患者中，通过血氧测定法测得的Qp/Qs比值范围为1.34至4.61，通过脉冲多普勒超声心动图测得的范围为1.31至4.46（p=无显著差异）。在这16例患者中，通过血氧测定法和脉冲多普勒超声心动图确定的Qp/Qs比值之间存在显著相关性（r = 0.82，标准误=0.54）。在32例患者的总组中，相关性更强（r = 0.93，标准误=0.37）。有创和无创分流计算之间未出现系统性差异。因此，对于患有继发孔型房间隔缺损且超声心动图质量高的成年患者，通过脉冲多普勒超声心动图可准确评估左向右分流的大小。在无肺动脉高压的情况下，脉冲多普勒超声心动图可为采取保守治疗或手术治疗的决策提供精确信息。
