超声心动图对低龄患儿主动脉瓣狭窄瓣膜成形术的评价

Clinical Value of Echocardiography on Aortic Valvuloplasty in Low-age Pediatric Patients With Congenital Aortic Valve Stenosis

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，探讨超声心动网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）nds，（3．01±0．83）nds，P〈0．01）;[MPG：（45．78±15．19）mmHg（1mmHg=0．133kPa），（18．24±10．08）mmHg，（21．01±10．08）mmHg，（22．31±13．41）mmHg，P〈0．011；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=O．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。

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） ml/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-opcrative 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, both P〈0.05, and aorta valve regurgitation （AR） was increased P〈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 （t= 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 first 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.