二维应变评估藏区动脉导管未闭患儿介入后右心室心肌收缩功能

Two-dimensional strain for evaluating right ventricular systolic function after interventional therapy of patent ductus arteriosus in Tibetan children

目的应用二维应变成像技术评估高海拔缺氧地区动脉导管未闭(patent ductus arteriosus,PDA)患儿介入封堵前后右心室局部心肌收缩功能的变化。方法来自高原藏区PDA的31例患儿,于术前1 d及术后7 d行超声心动图检查。同期选择无心脏疾病的儿童20例作为对照组,行超声心动图检查,图像导入Echo PAC超声工作站,人工将右心室游离壁及室间隔各划分为三个节段,测量节段心肌的收缩功能。结果术前藏区组室间隔基底段、中间段及心尖段,右室游离壁三个节段应变均低于对照组,而术后1周藏区患儿室间隔3个节段与对照组无统计学差异,右室游离壁3个节段应变仍低于对照组(P<0.01)。藏区组术后室间隔基底段及中间段、右室游离壁基底段、中间段应变较术前增高(P<0.01),心尖段应变较术前增高(P<0.05),而室间隔心尖段应变与术前相比无统计学差异。结论藏区患儿介入手术后短期内右室游离壁心肌收缩运动及肺动脉压力仍不能恢复至正常水平。二维应变技术可无创、定量评估PDA介入前后心肌的收缩功能。

Objective To study the right ventricular systolic function after interventional closure of patent ductus arteriosus in Tibetan children by two-dimensional strain imaging technique.Methods The sample consisted of thirty-one PDA children in the Tibetan region.The TEE was in stable condition one day before and seven days after closure.The other twenty children were recruited as control group.More than three continuous cardiac cycles were taken and induced into Echo PAC before the curve of systole peak strain was obtained.Results The strain of the septal and right ventricular wall was lower than that in control group before closure.There was no difference in septal segments between Tibetan and control group after closure,but the strain in the Tibetan group was still lower than that in control group in the right ventricular wall after closure（P〈0.01）.The strain of the basal and middle ventricular septal and basal and middle right ventricular wall increased（P〈0.01）,as in the right ventricular wall（P〈0.05）.Apical ventricular septal strain increased but the difference was not statistically significant.Conclusions Myocardial systolic function of the right ventricular wall cannot be restored quickly after closure,so a long period of follow-up is required.Two-dimensional technique can quantitatively evaluate the myocardial contraction in PDA patients and is more sensitive than the value of EF.