Cabrera A, Arriola J, Rumoroso J R, Rodrigo D, López-Bayón J, Fernández M A, Pastor E, Galdeano J M, Arriandiaga J R
Servicio de Cardiología Pediátrica, Hospital de Cruces, Baracaldo, Vizcaya.
Rev Esp Cardiol. 1995 May;48(5):318-25.
Bidimensional and color-coded Doppler echocardiography were used to study 19 patients with univentricular heart, permeable atrioventricular valves, muscular bulbo-ventricular foramen and an anterior rudimentary chamber. We evaluated the influence of the foramen upon the size of the great vessels, and in consequence the most appropriated surgical techniques.
The foramen was measured in two projections at the end of the systolic period, and its area was calculated, according to the body surface, with the formula S = pi (D1/2 x D2/2). Indexes lower than 2 cm2/m2 were considered as restrictive. We studied 19 patients that presented a mean age of 11 +/- 12 years (range 1 day-39 years). The patients were classified in two groups. Group A: patients who had transposition of the great vessels (13 cases). Group B: patients who had normal connection of the great vessels (6 cases). Each group was classified in two subgroups: subgroup 1, patients who presented a restrictive foramen, and subgroup 2, patients who presented a normal foramen. In this study, we evaluated the associated cardiac anomalies.
Group A. Thirteen cases. The index value for the whole group was 2.47 +/- 1.18 cm2/m2. The first subgroup included 6 cases with a restrictive foramen, 2 patients presented pathology of the arch. Four patients had a pressure gradient between the ventricle and the rudimentary chamber beyond 20 mmHg. The index of this subgroup was 1.68 +/- 0.39 cm2/m2, the median was 1.7. Seven cases, with a normal foramen, were included in the second subgroup, six of them had pulmonary valve stenosis, and the other one had undergone a pulmonary artery bandage 2 months before. Only one patient had a gradient pressure at the foramen beyond 20 mmHg. The index for this second subgroup was 3.34 +/- 0.83 cm2/m2.
Six patients with normal connection of the great vessels were included. The index was 1.56 +/- 1.17 cm2/m2. The first subgroup included 3 cases with a restrictive foramen. The index was 0.72 +/- 0.29 cm2/m2 (range 0.41-1) and the median was 0.75. Pressure gradient between the ventricle and the rudimentary chamber was greater than 20 mmHg. Three patients with a normal foramen were in the second subgroup and here, the index was under normal limits 2.4 +/- 0.52 cm2/m2 (range 2.1-3), the median was 2.1. One patient underwent a pulmonary artery bandage two months before.
Bulbo-ventricular foramen size/body surface index may exert an influence on the size of the vessel connected to the rudimentary chamber. The index vary in a negative way with the evolution time, or in those cases with transposition of the great vessels after a pulmonary artery bandage. Whenever the foramen is restrictive, the pulmonary artery or the aorta have a smaller diameter and the pressure gradient between the ventricle and the rudimentary chamber rises.
采用二维及彩色编码多普勒超声心动图对19例单心室心脏、房室瓣可通透、肌性球室孔及前方残腔的患者进行研究。我们评估了球室孔对大血管大小的影响，以及由此得出最合适的手术技术。
在收缩期末期于两个投影方向测量球室孔，并根据体表面积用公式S = π (D1/2 × D2/2) 计算其面积。低于2 cm2/m2的指数被视为狭窄。我们研究了19例平均年龄为11 ± 12岁（范围1天至39岁）的患者。患者被分为两组。A组：大动脉转位患者（13例）。B组：大动脉连接正常患者（6例）。每组再分为两个亚组：亚组1，球室孔狭窄的患者；亚组2，球室孔正常的患者。在本研究中，我们评估了相关的心脏异常情况。
A组。共13例。全组指数值为2.47 ± 1.18 cm2/m2。第一个亚组包括6例球室孔狭窄的患者，2例存在主动脉弓病变。4例患者心室与残腔之间的压力阶差超过20 mmHg。该亚组指数为1.68 ± 0.39 cm2/m2，中位数为1.7。第二个亚组包括7例球室孔正常的患者，其中6例有肺动脉瓣狭窄，另1例在2个月前接受了肺动脉环扎术。只有1例患者球室孔处的压力阶差超过20 mmHg。该第二个亚组的指数为3.34 ± 0.83 cm2/m2。
B组：包括6例大动脉连接正常的患者。指数为1.56 ± 1.17 cm2/m2。第一个亚组包括3例球室孔狭窄的患者。指数为0.72 ± 0.29 cm2/m2（范围0.41 - 1），中位数为0.75。心室与残腔之间的压力阶差大于20 mmHg。第二个亚组有3例球室孔正常的患者，此处指数低于正常范围2.4 ± 0.52 cm2/m2（范围2.1 - 3），中位数为2.1。1例患者在2个月前接受了肺动脉环扎术。
球室孔大小/体表面积指数可能会影响与残腔相连的血管大小。该指数随时间推移呈负向变化，或在大动脉转位且接受肺动脉环扎术的情况下出现这种变化。只要球室孔狭窄，肺动脉或主动脉直径就会变小，心室与残腔之间的压力阶差就会升高。
