CAJ | 학술논문

目的利用常规二维超声和斑点追踪技术(speckle tracking image,STI)对室间隔完整型大动脉转位(transposition of the great arteries,TGA)患儿新生儿期后的左心室发育进行评估,从中筛选出最为敏感的超声影像学指标,为患者术式选择提供依据.方法入选22例新生儿期后室间隔完整型TGA患儿,根据术中心室测压决定接受肺动脉环缩术(pulmonary artery banding,PAB)(PAB组,10例)或大动脉调转术(arterial switch operation,ASO)(ASO组,12例).15例年龄、体质量相匹配的的健康婴儿作为对照组.术前采集左室心尖和基底段短轴观的二维灰阶动态图像,脱机分析不同水平室壁的旋转角度、左室总体扭转角度等指标.结果所有患儿术后均存活出院.术前常规超声提示两组患儿均存在左室萎缩的表现.与对照组相比,PAB组和ASO组的射血分数、室壁厚度无差异,但左室舒张末内径、容积及左室质量指数均显著减少.PAB组和ASO组之间左室舒张末内径、容积及左室质量指数差异均无统计学意义.STI分析表明,两组患儿的左室心尖部和心底部整体旋转角度、左室总体扭转角度与对照组相比存在差异,但PAB组心尖部整体旋转角度、旋转角度达峰时间以及左室总体扭转角度较对照组和ASO组均显著减少.结论常规二维超声检查可以初步对超过最佳治疗时期的TGA患儿的心室发育进行评估,但STI技术可以更精确地评价患儿左室退化的程度.心尖部整体旋转角度、旋转角度达峰时间和左室总体扭转角度有助于甄别出边缘状态的退化左室,对术式的选择有重要的参考价值.
목적 이용상규이유초성화반점추종기술(speckle tracking image,STI)대실간격완정형대동맥전위(transposition of the great arteries,TGA)환인신생인기후적좌심실발육진행평고,종중사선출최위민감적초성영상학지표,위환자술식선택제공의거.방법 입선22례신생인기후실간격완정형TGA환인,근거술중심실측압결정접수폐동맥배축술(pulmonary artery banding,PAB)(PAB조,10례)혹대동맥조전술(arterial switch operation,ASO)(ASO조,12례).15례년령、체질량상필배적적건강영인작위대조조.술전채집좌실심첨화기저단단축관적이유회계동태도상,탈궤분석불동수평실벽적선전각도、좌실총체뉴전각도등지표.결과 소유환인술후균존활출원.술전상규초성제시량조환인균존재좌실위축적표현.여대조조상비,PAB조화ASO조적사혈분수、실벽후도무차이,단좌실서장말내경、용적급좌실질량지수균현저감소.PAB조화ASO조지간좌실서장말내경、용적급좌실질량지수차이균무통계학의의.STI분석표명,량조환인적좌실심첨부화심저부정체선전각도、좌실총체뉴전각도여대조조상비존재차이,단PAB조심첨부정체선전각도、선전각도체봉시간이급좌실총체뉴전각도교대조조화ASO조균현저감소.결론 상규이유초성검사가이초보대초과최가치료시기적TGA환인적심실발육진행평고,단STI기술가이경정학지평개환인좌실퇴화적정도.심첨부정체선전각도、선전각도체봉시간화좌실총체뉴전각도유조우견별출변연상태적퇴화좌실,대술식적선택유중요적삼고개치.
Objective To identify the suitable echocardiographic predictor,the standard 2-demensional echocardiography and speckle tracking imaging (STI) techniques were applied for the late referred children with transposition of great arteries with intact ventricular septum (TGA-IVS) after neonatal period.Methods 22 children with TGA-IVS after neonatal period were enrolled.According to the intraoperative left ventricular (LV)/right ventricular systolic pressure ratio,they received pulmonary artery banding (PAB group,n =10) or arterial switch operation (ASO group,n =12).15 body surface area matched healthy children were served as control group,Echocardiography was performed before the operation.The dynamic images in basal and apical short axis view were collected respectively.Meanwhile,using the STI technique,the rotation curves at apex and base was analyzed.Results All the patients discharged eventually.A right to left bulging of the ventricular septum was observed in all the patients by the 2D short-axis view.There were no differences in wall thickness and ejection fraction between control,PAB and ASO group.Compared with the control group,the end diastolic diameter,end diastolic volume and indexed LV mass in PAB and ASO group were significantly reduced,however,no difference in the end diastolic diameter and volume and LV mass was observed between the PAB and ASO group.The hypoplasia of LV in PAB and ASO group was associated with an extended time to peak basal rotation and reduced basal rotation and global torsion.Furthermore,the shorter time to peak apical rotation and reduced apical rotation and global torsion were only observed in PAB group.Conclusions The standard echocardiography could be useful for the initial evaluation for regressed LV of the children with TGA-IVS.However,STI allows a much more precious approach to the assessment of LV regressing after neonatal period.The apical rotation and global torsion might be the better predictor to identify the borderline or regressed LV for the surgical management for the children with TGA-IVS.