Fogel M A, Donofrio M T, Ramaciotti C, Hubbard A M, Weinberg P M
Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104.
Circulation. 1994 Dec;90(6):2927-36. doi: 10.1161/01.cir.90.6.2927.
Because pulmonary artery size is considered by most investigators to be a major prognosticator of outcome in patients undergoing staged Fontan reconstruction, the objective of the present study was to determine the efficacy of noninvasive measures in determining pulmonary artery size.
This study analyzed the T1-weighted, spin-echo magnetic resonance and echocardiographic images of 36 functional single-ventricle patients throughout stages of Fontan reconstruction (prebidirectional and postbidirectional cavopulmonary anastomosis and after Fontan) and compared them with angiography images at cardiac catheterization. Magnetic resonance imaging had a high degree of agreement with angiography, with the McGoon index agreeing better than the Nakata index and absolute right and left pulmonary diameters. Although echocardiography had fair agreement with angiography, it agreed less well and had a wider standard deviation than magnetic resonance imaging for all indexes and measurements and, based on the prediction interval, would be a poorer prospective measure of pulmonary artery size in this population. In addition, echocardiography was a poorer measure of pulmonary artery size as the size of the vessel increases. Magnetic resonance imaging correctly detected five of five patients with nonconfluent branch pulmonary arteries and six of six patients with stenoses, whereas echocardiography was unable to visualize any of the patients with nonconfluent branch pulmonary arteries with certainty and only two of six (33%) with stenoses.
Magnetic resonance imaging is a useful, noninvasive tool to determine pulmonary artery size in patients undergoing Fontan reconstruction and is superior to echocardiography. Echocardiography was a fair predictor of pulmonary artery size, but magnetic resonance imaging agreed with angiography better than echocardiography and outperformed echocardiography in diagnosing branch pulmonary artery discontinuity and stenoses. Magnetic resonance imaging may avoid unnecessary cardiac catheterization, especially in older patients, and may obviate the need for jugular or subclavian catheterization in those who have undergone bidirectional cavopulmonary anastomosis.
由于大多数研究者认为肺动脉大小是接受分期Fontan重建手术患者预后的主要预测指标，本研究的目的是确定非侵入性测量方法在测定肺动脉大小方面的有效性。
本研究分析了36例功能性单心室患者在Fontan重建各阶段（双向腔肺吻合术前、双向腔肺吻合术后及Fontan术后）的T1加权自旋回波磁共振成像和超声心动图图像，并与心导管检查时的血管造影图像进行比较。磁共振成像与血管造影有高度一致性，McGoon指数比Nakata指数以及左右肺动脉绝对直径的一致性更好。虽然超声心动图与血管造影有一定一致性，但与磁共振成像相比，其一致性较差，所有指标和测量的标准差更大，并且基于预测区间，在该人群中对肺动脉大小的前瞻性测量效果较差。此外，随着血管尺寸增加，超声心动图对肺动脉大小的测量效果更差。磁共振成像正确检测出了5例分支肺动脉不连续患者中的5例以及6例狭窄患者中的6例，而超声心动图无法确定任何一例分支肺动脉不连续患者的情况，对于6例狭窄患者仅检测出2例（33%）。
磁共振成像是一种用于测定接受Fontan重建手术患者肺动脉大小的有用的非侵入性工具，优于超声心动图。超声心动图是肺动脉大小的一个尚可的预测指标，但磁共振成像与血管造影的一致性优于超声心动图，在诊断分支肺动脉不连续和狭窄方面也优于超声心动图。磁共振成像可避免不必要的心导管检查，尤其是在老年患者中，并且对于已经接受双向腔肺吻合术的患者，可能无需进行颈静脉或锁骨下静脉导管插入术。
