中国循环杂志
中國循環雜誌
중국순배잡지
Chinese Circulation Journal
2015年
9期
875-878
,共4页
徐楠%张红菊%孙欣%吴伟春%孟红%逄坤静%朱振辉%王浩%李守军%闫军
徐楠%張紅菊%孫訢%吳偉春%孟紅%逄坤靜%硃振輝%王浩%李守軍%閆軍
서남%장홍국%손흔%오위춘%맹홍%방곤정%주진휘%왕호%리수군%염군
超声心动图%主动脉瓣成形术
超聲心動圖%主動脈瓣成形術
초성심동도%주동맥판성형술
Echocardiography%Aortic valvuloplasty
目的::应用超声心动图评价因先天性主动脉瓣狭窄接受主动脉瓣成形术(AVP)低龄患儿的心脏结构及血流动力学特点,探讨超声心动图在先天性主动脉瓣成形术中的临床价值。方法:回顾分析39例因先天性主动脉瓣狭窄在我院接受主动脉瓣成形术的低龄患儿(年龄中位数23个月)的超声心动图资料。将超声主要指标在术前、术后1周、1~3个月及6~12个月四个时间段的变化进行统计学分析。结果:本研究中主动脉瓣分叶二叶与三叶比例约5.5:1,围术期共2例死亡。手术前、术后1周、1~3个月及6~12个月后经胸超声测量数据相比较,术后各时间段主动脉瓣峰值流速(Vmax)及平均跨瓣压差(MPG)均较术前减低[Vmax:(4.30±0.73) m/s,(2.65±0.78) m/s,(2.93±0.63) m/s,(3.01±0.83) m/s,P<0.01];[MPG:(45.78±15.19) mmHg(1 mmHg=0.133 kPa),(18.24±10.08)mmHg,(21.01±10.08)mmHg,(22.31±13.41)mmHg,P<0.01];术后各时间较术前左心室射血分数(LVEF)无明显变化;左心室舒张末径(LVEDD)术后6~12个月较术后1周增加(P<0.05);相对室壁厚度(RWT)术后6~12个月较术前及术后1周减低(P<0.05);主动脉瓣反流(AR)术后6~12个月较术前增加(P<0.01)。Pearson相关性分析显示主动脉瓣环内径(AA)与LVEDD呈正相关(r=0.648,P<0.01),AA与Vmax呈负相关(r=-0.205,P<0.05),RWT与Vmax呈正相关(r=0.196,P<0.05)。患儿中术前LVEF减低的6例,除1例死亡外,其余5例术后6~12个月时LVEF较术前有所提高(P<0.05)。结论:超声心动图可作为先天性主动脉瓣狭窄的首选影像诊断方法,在AVP术前诊断、术中监测及术后评价方面发挥重要价值。
目的::應用超聲心動圖評價因先天性主動脈瓣狹窄接受主動脈瓣成形術(AVP)低齡患兒的心髒結構及血流動力學特點,探討超聲心動圖在先天性主動脈瓣成形術中的臨床價值。方法:迴顧分析39例因先天性主動脈瓣狹窄在我院接受主動脈瓣成形術的低齡患兒(年齡中位數23箇月)的超聲心動圖資料。將超聲主要指標在術前、術後1週、1~3箇月及6~12箇月四箇時間段的變化進行統計學分析。結果:本研究中主動脈瓣分葉二葉與三葉比例約5.5:1,圍術期共2例死亡。手術前、術後1週、1~3箇月及6~12箇月後經胸超聲測量數據相比較,術後各時間段主動脈瓣峰值流速(Vmax)及平均跨瓣壓差(MPG)均較術前減低[Vmax:(4.30±0.73) m/s,(2.65±0.78) m/s,(2.93±0.63) m/s,(3.01±0.83) m/s,P<0.01];[MPG:(45.78±15.19) mmHg(1 mmHg=0.133 kPa),(18.24±10.08)mmHg,(21.01±10.08)mmHg,(22.31±13.41)mmHg,P<0.01];術後各時間較術前左心室射血分數(LVEF)無明顯變化;左心室舒張末徑(LVEDD)術後6~12箇月較術後1週增加(P<0.05);相對室壁厚度(RWT)術後6~12箇月較術前及術後1週減低(P<0.05);主動脈瓣反流(AR)術後6~12箇月較術前增加(P<0.01)。Pearson相關性分析顯示主動脈瓣環內徑(AA)與LVEDD呈正相關(r=0.648,P<0.01),AA與Vmax呈負相關(r=-0.205,P<0.05),RWT與Vmax呈正相關(r=0.196,P<0.05)。患兒中術前LVEF減低的6例,除1例死亡外,其餘5例術後6~12箇月時LVEF較術前有所提高(P<0.05)。結論:超聲心動圖可作為先天性主動脈瓣狹窄的首選影像診斷方法,在AVP術前診斷、術中鑑測及術後評價方麵髮揮重要價值。
목적::응용초성심동도평개인선천성주동맥판협착접수주동맥판성형술(AVP)저령환인적심장결구급혈류동역학특점,탐토초성심동도재선천성주동맥판성형술중적림상개치。방법:회고분석39례인선천성주동맥판협착재아원접수주동맥판성형술적저령환인(년령중위수23개월)적초성심동도자료。장초성주요지표재술전、술후1주、1~3개월급6~12개월사개시간단적변화진행통계학분석。결과:본연구중주동맥판분협이협여삼협비례약5.5:1,위술기공2례사망。수술전、술후1주、1~3개월급6~12개월후경흉초성측량수거상비교,술후각시간단주동맥판봉치류속(Vmax)급평균과판압차(MPG)균교술전감저[Vmax:(4.30±0.73) m/s,(2.65±0.78) m/s,(2.93±0.63) m/s,(3.01±0.83) m/s,P<0.01];[MPG:(45.78±15.19) mmHg(1 mmHg=0.133 kPa),(18.24±10.08)mmHg,(21.01±10.08)mmHg,(22.31±13.41)mmHg,P<0.01];술후각시간교술전좌심실사혈분수(LVEF)무명현변화;좌심실서장말경(LVEDD)술후6~12개월교술후1주증가(P<0.05);상대실벽후도(RWT)술후6~12개월교술전급술후1주감저(P<0.05);주동맥판반류(AR)술후6~12개월교술전증가(P<0.01)。Pearson상관성분석현시주동맥판배내경(AA)여LVEDD정정상관(r=0.648,P<0.01),AA여Vmax정부상관(r=-0.205,P<0.05),RWT여Vmax정정상관(r=0.196,P<0.05)。환인중술전LVEF감저적6례,제1례사망외,기여5례술후6~12개월시LVEF교술전유소제고(P<0.05)。결론:초성심동도가작위선천성주동맥판협착적수선영상진단방법,재AVP술전진단、술중감측급술후평개방면발휘중요개치。
Objective: To evaluate the clinical value of echocardiography in aortic valvuloplasty (AVP) in the low-age pediatric patients with congenital aortic valve stenosis. Methods: We retrospectively studied 39 low-age (at median of 23 months) patients with congenital aortic valve stenosis who received aortic valve repair in our hospital for their echocardiography information, and statistically analyzed the main indicator changes by 4 time points as pre-operation and 1 week, 1-3 months, 6-12 months after the operation respectively. Results: In our study, the bicuspid to tricuspid valve ratio was approximately at 5.5/1 and 2 patients died during peri-operative period. Compared with pre-operative time point, Doppler aortic valve peak velocity (Vmax ) and the mean aortic transvalvular pressure gradient (MPG) were reduced accordingly, for Vmax: (4.30 ± 0.73) m/s vs (2.65 ± 0.78) m/s, (2.93 ± 0.63) m/s, (3.01 ± 0.83) m/s,P<0.01, for MPG: (45.78 ± 15.19) mmHg vs (18.24 ± 10.08) mmHg, (21.01 ± 10.08) mmHg, (22.31 ± 13.41) mmHg. Compared with pre-operative time point, left ventricular ejection fractions (LVEF) were similar in 3 post-operative time points. Compared with 1 week post operative time point, left ventricular end-diastolic anteroposterior diameter (LVEDD) was increased at 6-12 months post-operative time point, the relative wall thickness (RWT) was decreased, bothP<0.05, and aorta valve regurgitation (AR) was increasedP<0.01. Pearson correlation analysis showed that aortic annulus (AA) inner diameter was positively related to LVEDD (r= 0.648,P<0.01), negatively related to Vmax (r= -0.205,P<0.05) and RWT was positively related to Vmax (r= 0.196,P<0.05). There were 6 patients with pre-operatively decreased LVEF, 1 of them died and the rest 5 with elevated LVEF at 6-12 months post-operative period,P<0.05. Conclusion: Echocardiograghy could be used as the ifrst choice of imaging method for diagnosing congenital aortic valve stenosis, it has the important role for in-operative monitoring and post-operative evaluation of AVP in relevant patients.