Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
J Am Soc Echocardiogr. 2021 Aug;34(8):877-886. doi: 10.1016/j.echo.2021.03.004. Epub 2021 Mar 19.
The aims of this study were to investigate the dynamic changes in the vena contracta (VC) and proximal isovelocity surface area (PISA) through systole in patients with hypoplastic left heart syndrome and tricuspid regurgitation and to identify the stage of systole (early, mid, or late) in which VC and PISA radius are optimal.
Twenty-eight patients with hypoplastic left heart syndrome were prospectively studied using continuous two-dimensional (2D) and three-dimensional (3D) echocardiography. Two-dimensional VC width, 3D VC area, and PISA radii (2D and 3D) were measured frame by frame throughout systole. The maximal 2D VC width, 3D VC area, and PISA radii in the first, middle, and last thirds of systole were compared, and correlations were explored with 3D tricuspid annular areas, right atrial volumes, and right ventricular volumes.
In all, 35 data sets that met inclusion criteria were analyzed. On frame-by-frame analysis, maximal 2D VC width and 3D VC area were found in the first third of systole in 17% and 20% of studies, in the second third in 34% and 31%, and in the final third in 49% and 49%. Similarly, the maximal 2D and 3D PISA radii were found in the first third of systole in 26% and 17% of studies, in the second third in 28% and 34%, and in the final third in 46% and 49%.
In hypoplastic left heart syndrome, detailed temporal analysis of tricuspid regurgitation-associated VC and PISA by 2D and 3D echocardiography reveals no reliable pattern predicting when in systole these parameters peak. Frame-by-frame measurement is necessary for identification of maximal VC and PISA radius on 2D and 3D color Doppler echocardiography because the severity of tricuspid regurgitation could be underestimated because of temporal variability in VC and PISA.
本研究旨在探讨左心发育不全综合征伴三尖瓣反流患者收缩期静脉收缩（VC）和近等速表面积（PISA）的动态变化，并确定 VC 和 PISA 半径最佳的收缩期阶段（早期、中期或晚期）。
前瞻性研究了 28 例左心发育不全综合征患者，采用二维（2D）和三维（3D）超声心动图连续测量。逐帧测量收缩期 VC 宽度、3D VC 面积和 PISA 半径（2D 和 3D）。比较收缩期前 1/3、中 1/3和后 1/3时最大 2D VC 宽度、3D VC 面积和 PISA 半径，并与 3D 三尖瓣环面积、右心房容积和右心室容积进行相关性分析。
共分析了 35 个符合纳入标准的数据组。在逐帧分析中，17%和 20%的研究中最大 2D VC 宽度和 3D VC 面积出现在收缩期的前 1/3，34%和 31%出现在中 1/3，49%和 49%出现在最后 1/3。同样，最大 2D 和 3D PISA 半径分别在收缩期前 1/3、中 1/3和后 1/3的 26%、28%和 46%、17%、34%和 49%。
二维和三维超声心动图对三尖瓣反流相关 VC 和 PISA 的详细时间分析显示，在收缩期，这些参数何时达到峰值没有可靠的模式。由于 VC 和 PISA 的时间变化，二维和三维彩色多普勒超声心动图上需要逐帧测量才能识别最大 VC 和 PISA 半径，因为三尖瓣反流的严重程度可能会因 VC 和 PISA 的时间变化而被低估。
