Cáceres Espejo J, Santos de Soto J, Gavilán Camacho J L, Cabello Laureano R, Grueso Montero J, Descalzo Señorans A
Servicio de Cardiología y Hemodinámica Pediátrica, Hospital Infantil Universitario Virgen del Rocío, Sevilla.
Rev Esp Cardiol. 1995 Feb;48(2):122-7.
We analysed the usefulness of Doppler echocardiography to determine the presence and severity of pulmonary hypertension (PH) in children.
The whole group consisted of 63 patients, 42 with congenital heart disease that underwent cardiac catheterization (32 of whom had PH = study group) and 21 healthy children. These 21 patients and the remaining 10 without PH at cardiac catheterization made up the control group. All children were studied with Doppler Echocardiography to evaluate the pulmonary flow pattern with the sample volume placed in the pulmonary artery trunk, 1 cm distal to the pulmonic valve. The preejection period (PEP), ejection period (EP), acceleration time (AcT), the indexes PEP/EP, PEP/AcT, AcT/EP and the morphologic pattern of the pulmonary flow (type I: with peak flow velocity at midsystole; type II: with peak flow velocity in early systole; type III: with midsystolic notching) were analysed and quantitative parameters corrected according to hear rate by dividing theirs value by the square root of R-R interval. In the hemodynamic study we analysed the systolic (SPAP), diastolic and mean pulmonary artery pressure, and the mean pulmonary pressure/mean systemic pressure ratio (Pp/Sp). We compared the echocardiographic variables in both, study and control groups, and analysed the hemodynamic and echocardiographic correlation between the variables in question.
Pattern I of pulmonary flow was associated with absence of PH and pattern II and III with PH (p < 0.001). The best results of quantitative variables were either corrected AcT (AccT) rather less in the study group than in control group (2.89 +/- 0.56 vs 4.05 +/- 0.56 ms, p < 0.001) and PPE/AcT index, 1.28 +/- 0.3 in the hypertensive group and 0.78 +/- 0.16 in the control group (p < 0.001). The best correlation were AcT with SPAP (r = -0.82) and Act with Pp/Sp ratio (r = -0.84).
We consider that pulmonary flow analysed with Doppler echocardiography is a reliable, suitable and non-invasive method to evaluate PH in children.
我们分析了多普勒超声心动图在确定儿童肺动脉高压（PH）的存在及严重程度方面的实用性。
整个研究组由63名患者组成，其中42例患有先天性心脏病并接受了心导管检查（其中32例患有PH，为研究组），21例为健康儿童。这21例患者以及心导管检查时其余10例无PH的患者组成了对照组。所有儿童均接受多普勒超声心动图检查，将取样容积置于肺动脉干距肺动脉瓣1厘米处，以评估肺血流模式。分析射血前期（PEP）、射血期（EP）、加速时间（AcT）、PEP/EP、PEP/AcT、AcT/EP指数以及肺血流的形态模式（I型：收缩中期峰值流速；II型：收缩早期峰值流速；III型：收缩中期切迹），并通过将其值除以R-R间期的平方根来根据心率校正定量参数。在血流动力学研究中，我们分析了收缩期（SPAP）、舒张期和平均肺动脉压，以及平均肺动脉压/平均体循环压力比值（Pp/Sp）。我们比较了研究组和对照组的超声心动图变量，并分析了相关变量之间的血流动力学和超声心动图相关性。
肺血流I型与无PH相关，II型和III型与PH相关（p < 0.001）。定量变量的最佳结果是校正后的AcT（AccT），研究组低于对照组（2.89±0.56对4.05±0.56毫秒，p < 0.001）以及PPE/AcT指数，高血压组为1.28±0.3，对照组为0.78±0.16（p < 0.001）。最佳相关性为AcT与SPAP（r = -0.82）以及Act与Pp/Sp比值（r = -0.84）。
我们认为，用多普勒超声心动图分析肺血流是评估儿童PH的一种可靠、适用且无创的方法。
