超声斑点追踪技术评价肺动脉环缩术后心室发育程度的初步研究

Application of speckle tracking imaging for evaluation of the development of left ventricle after receiving pulmonary artery banding

目的 利用超声斑点追踪（STI）技术对超过最佳根治年龄的室间隔完整型大动脉转位（TGA）患儿接受肺动脉环缩术（PAB）前后的左室发育进行评估,从中筛选出较为敏感的STI指标,为低龄患儿的心室功能评估提供新的指标.方法 对7例年龄大于3月的超过最佳根治年龄的室间隔完整型TGA接受肺动脉环缩术（PAB组）患儿进行左室训练.8例年龄、体质量相匹配的的健康婴儿作为对照组.应用STI技术分析两组患儿左室不同水平室壁的旋转角度,左室整体扭转角度等指标.结果 所有患儿接受PAB后均存活出院.术中测压提示左室和右室压力之比为（0.32±0.04）：1.与对照组相比,PAB组术前射血分数、室壁厚度差异无统计学意义,但左室舒张末内径和容积显著减小.术前PAB组心底和心尖的局部旋转角度和达峰时间以及整体扭转角度与对照组显著不同.其中,术前心尖部和心底部旋转角度较对照组减小约3倍.结论 左室局部的旋转和整体扭转角度的改变可能是较敏感的STI指标,可用于评价TGA患儿PAB术前心室退化以及术后心室发育的变化.

Objective To identify the suitable echocardiographic predictor of speckle tracking imaging （STI） for evaluation of development of left ventricle（LV） after pulmonary artery banding （PAB）.Methods Seven children older than 3 months with transposition of great arteries with intact ventricular septum （TGA） were enrolled,they received pulmonary artery banding （PAB group）.Eight body surface area matched healthy children were severed as control group.Using the STI technique,the rotation curves at apex and base were analyzed.Results All the patients discharged eventually.The intraoperative LV/RV systolic pressure ratio in PAB group was （0.32 ± 0.04）：1.There were no differences in ejection fraction and wall thickness between control and PAB group.However,the end diastolic diameter and end diastolic volume in PAB group was significantly reduced.Compared with the control group,the hypoplasia of LV in PAB group was associated with an extended time to peak basal rotation,and furthermore,the basal and global torsion was significantly reduced by 3 times.Conclusions STI showed local rotation and global torsion might be thevaluable predictor to evaluate the regressed and the development of LV peri-PAB procedure for the older children with TGA.