三维斑点追踪技术评估三尖瓣闭锁左室收缩功能

Assessment of systolic function of children with tricuspid atresia using three-dimensional speckle tracking echocardiography

目的应用三维超声斑点追踪技术估测三尖瓣闭锁患儿腔-肺动脉吻合术前及术后心室收缩功能。方法三尖瓣闭锁患儿15例于Glenn术前及术后分别进行三维超声检查和心脏磁共振检查,并取年龄、性别匹配的正常儿童进行三维超声检查,分析收缩功能并比较。结果与正常儿童对比,三尖瓣闭锁患儿术前射血分数[(57.886±2.112)%vs(63.986±3.236)%]、扭转角度[(7.428±1.771)°vs(11.632±1.937)°]、扭力[(2.119±0.599)°/cm vs(3.083±0.553)°/cm]、心底旋转角度[(-3.789±1.201)°vs(-6.674±1.132)°]减小(P<0.01),术后射血分数、扭转角度、扭力、心底旋转角度数值较术前增大(P<0.05)。心底旋转角度与三维超声估测的射血分数相关性较好(r=0.822)。结论三尖瓣闭锁患儿心室收缩功能和扭转运动减弱,术后有所改善;三维超声斑点追踪技术可以比较准确地评估三尖瓣闭锁患儿左室的心功能;心底旋转角度是评估心室收缩功能的良好指标。

Objective To evaluate the systolic function of the left ventricle in tricuspid atresia （TA） before and after cavopulmonary connection （Glenn） operation by three-dimensional speckle tracking echocardiography （3DSTE）. Methods Fifteen patients with TA were recruited, the systolic function was assessed by 3DSTE before and after Glenn palliation. In addition, age- and gender- matched healthy children （control group） were also included and divided into two groups by age, one matched with pre-op group （N1 group） and another with post-op group （N2 group）. The volumes and ejection fraction calculated by 3DSTE before and after Glenn palliation were compared to cardiac magnetic resonance measurements. The volumes, EF, twist, torsion, and rotation were assessed in patients before and after operation and healthy children by 3DSTE and compared with each other. Results Compared to control group, the ejection fraction （EF） 〔（57.886±2.112）% vs （63.986±3.236）%〕, twist （TW） 〔（7.428±1.771）° vs （11.632±1.937）°〕, torsion （TO） 〔（2.119±0.599）°/cm vs （3.083±0.553）°/cm〕, basal rotation （R B） 〔（-3.789±1.201）° vs （-6.674±1.132）°〕 were lower than control group, （ P 〈0.01）. After operation, the EF, TW, TO, and R B increased （ P 〈0.05）. R B was significantly correlated with LVEF （ r =0.822）. Conclusion TA had impaired ventricular function, which was partially improved by palliation surgery to a certain extent. 3DSTE was a reliable and convenient clinical assessment tool for evaluation of ventricular function. Basal rotation may be good indicator for LV global function.