室间隔完整型大动脉转位新生儿期后左心室发育的超声评价研究

Echocardiographic study for the children with transposition of the great arteries with intact ventricular septum after neonatal period

目的利用常规二维超声和斑点追踪技术（speckletrackingimage，STI）对室间隔完整型大动脉转位（transpositionofthegreatarteries，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。方法人选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（pulmonaryarterybanding，PAB）（PAB组，10例）或大动脉调转术（arterialswitchoperation，AS0）（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。STl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。

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 ventricutar septum （TGA-IVS） after neonatal period. Methods 22 children with TGA-IVS after neonatal period were enrolled. According to the intraoperative left ventrieular （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 shortaxis 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 enddiastolic 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.