Kovalchin J P, Brook M M, Rosenthal G L, Suda K, Hoffman J I, Silverman N H
Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston 77030, USA.
J Am Coll Cardiol. 1998 Jul;32(1):237-44. doi: 10.1016/s0735-1097(98)00218-6.
The purpose of this study was to identify echocardiographic hemodynamic and morphometric factors that would predict which infants with critical aortic stenosis could undergo relief of left ventricular outflow obstruction as opposed to the Norwood procedure.
Echocardiographic predictors of survival in infants with critical aortic stenosis after two-ventricle repair have been mainly limited to morphometric factors, which have limitations. Echocardiographic hemodynamic predictors of survival in these patients have not previously been studied.
Doppler color flow mapping and pulsed Doppler techniques were used to obtain hemodynamic measurements of flow in the ascending, transverse and descending aorta, the ductus arteriosus, and across the aortic and mitral valves in infants with critical aortic stenosis. Morphometric measurements of the left heart structures were obtained, and comparisons were made between survivors and nonsurvivors for the hemodynamic and morphometric factors.
Twenty-eight infants (mean age 1 +/- .6 days, mean weight 3.6 +/- .6 kg) with critical aortic stenosis were evaluated. Nineteen had a two-ventricle repair initially attempted, and nine had a Norwood operation. Among the patients with a two-ventricle repair, the hemodynamic factors associated with survival after two-ventricle repair included predominant or total antegrade flow in the ascending (p < 0.01) and transverse aorta (p < 0.05). Aortic valve gradient, mitral valve inflow and direction of flow in the ductus arteriosus and descending aorta were unrelated to outcome. The morphometric factors associated with survival after two-ventricle repair included the indexed aortic annulus (p < 0.0002), aortic root (p < 0.003), ascending aorta (p < 0.008) and left ventricular long-axis length (p < 0.01). Left ventricular volume, mass, ejection fraction and mitral valve area were not related to outcome after two-ventricle repair.
In infants with critical aortic stenosis, predominant or total antegrade flow in the ascending and transverse aorta was associated with survival after two-ventricle repair. Determination of a one- versus two-ventricle repair remains a complex issue in infants with critical aortic stenosis. In addition to established morphometric predictors, hemodynamic information on the direction of flow in the aorta may help to define candidates for the Norwood operation.
本研究的目的是确定超声心动图的血流动力学和形态学因素，以预测哪些患有严重主动脉狭窄的婴儿能够接受左心室流出道梗阻解除术，而非诺伍德手术。
在双心室修复术后，严重主动脉狭窄婴儿生存的超声心动图预测指标主要局限于形态学因素，这些因素存在局限性。此前尚未对这些患者生存的超声心动图血流动力学预测指标进行研究。
使用多普勒彩色血流图和脉冲多普勒技术，对患有严重主动脉狭窄的婴儿的升主动脉、横主动脉和降主动脉、动脉导管以及主动脉瓣和二尖瓣处的血流进行血流动力学测量。获取左心结构的形态学测量数据，并对幸存者和非幸存者的血流动力学和形态学因素进行比较。
对28例患有严重主动脉狭窄的婴儿（平均年龄1±0.6天，平均体重3.6±0.6千克）进行了评估。19例最初尝试进行双心室修复，9例接受了诺伍德手术。在双心室修复的患者中，与双心室修复后生存相关的血流动力学因素包括升主动脉（p<0.01）和横主动脉（p<0.05）中主要为顺行血流或全部为顺行血流。主动脉瓣梯度、二尖瓣血流以及动脉导管和降主动脉中的血流方向与预后无关。与双心室修复后生存相关的形态学因素包括指数化主动脉瓣环（p<0.0002）、主动脉根部（p<0.003）、升主动脉（p<0.008）和左心室长轴长度（p<0.01）。双心室修复后，左心室容积、质量、射血分数和二尖瓣面积与预后无关。
在患有严重主动脉狭窄的婴儿中，升主动脉和横主动脉中主要为顺行血流或全部为顺行血流与双心室修复后的生存相关。对于患有严重主动脉狭窄 的婴儿，确定进行单心室还是双心室修复仍然是一个复杂的问题。除了已确定的形态学预测指标外，主动脉血流方向的血流动力学信息可能有助于确定诺伍德手术的候选者。
