实时三维超声评估复杂型先心病手术前后左心功能

Pre-and post-operative assessment of left ventricular function incomplex congenital heart disease with real-time three-dimensional echocardiography

目的通过实时三维超声心动图(RT-3DE)评估复杂型先心病手术前后左心功能的对比研究,评价其临床价值。方法22例复杂型先心病经RT-3DE检查后,应用Tomtec三维容量测量软件的心尖长轴8平面法进行手术前后左心室舒张末和收缩末容量、搏出量及射血分数等左心功能指标的测量.并用配对t检验及直线相关分析进行对比研究。结果与术前(18.7±14.9)ml、(9.0±7.3)ml相比,术后左心室舒张末期容量(22.2±1 7.6)ml明显升高.术前后有显著性差异,而收缩末期容量(9.5±7.8)ml略升高,手术前、后差异无统计学意义。直线相关分析则示术前后收缩末期容量(r= 0.97)相关性高于舒张末期容量(r=0.95),提示术前左心功能降低主要与舒张末期容量较小有关。与术前相比,术后搏出量明显升高[(12.7±9.8)ml vs(9.6±7.6)ml],且术后射血分数(0.58±0.03 vs 0.52±0.03)也较术前增高,提示成功纠正左右心分流后左心功能改善,趋于正常。结论通过对复杂型先心病作出精确的心功能定量评估,RT-3DE可完善复杂型先心病术前功能诊断,并对手术矫治和术后随访、预后判断等有指导意义。

Objective To compare the pre-and post-operative left ventricular functions in children with complex congenital heart disease（CHD）with real-time three-dimensional echocardiography（RT-3DE）.Methods Twenty-two consecutive pa- tients with complex CHD were examined with Phillips RT-3DE System,the pre-and post-operative left ventricular functions such as left ventricular volume,stroke volume and ejection fraction were estimated and compared by Tomtec RT-3DE apical longitudinal 8-plane method,and the outcomes were assessed with paired t-test and Pearson＇s correlation coefficient analysis. Results Compared with pre-operative left ventricular end-diastolic and end-systolic volumes（18.7±14.9）ml and（9.0±7.3）ml,post-operative left ventricular end-diastolic volumes（22.2±17.6）ml increased after surgical intracardiac repair, while no obvious change of end-systolic volumes（9.5±7.8）ml was observed after surgical operation.Correlations of the pre-and postoperative left ventricular end-systolic volumes（r=0.97）were higher than those of the pre-and postoperative left ventricular end-diastolic volumes（r=0.95）.The results indicated that the preoperative left ventricular end-diastolic vol- umes in the preoperative assessment of left cardiac function was lessened more than its left ventricular end-systolic volumes. Accordingly,compared with pre-operative stroke volumes（9.6±7.6）ml,post-operative stroke volumes（12.7±9.8）ml markedly increased（P〈0.05）.Moreover,post-operative ejection fractions of left ventricles increased（0.58±0.03 vs 0.52±0.03）significant difference,suggestting that left cardiac functions were improved and gradually close to normal cardiac function after the left-to-right shunt was corrected.Conclusion RT-3DE can provide quantitative information of cardiac function for pre-and post-operative follow-up and prognostic prediction in complex CHD.