应用三维超声斑点追踪技术评估左室型单心室收缩功能的研究

Assessment of systolic function of children with single left ventricle using three-dimensional speckle tracking echocardiography

目的应用三维超声斑点追踪技术(three-dimensional speckle tracking echocardiography,3DSTE)研究左室型单心室患儿在腔-肺动脉吻合(Glenn)术前及术后心室收缩功能变化。方法左室型单心室患儿17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对照。结果与正常儿童对比,左室型单心室患儿术前射血分数(55. 567±3. 577)%vs (63. 628±3. 739)%、扭转角度(5. 776±2. 819)°vs (11. 801±1. 769)°、扭力(1. 653±0. 860)°/cm vs (3. 123±0. 490)°/cm)、心尖旋转角度(2. 135±2. 303)°vs (5. 415±1. 562)°、心底旋转角度(-3. 672±1. 751)°vs (-6. 490±1. 090)°明显减低(P <0. 01),术后射血分数、扭转角度、扭力、心底旋转角度较术前增大(P <0. 05)。心底旋转角度与EF3DSTE相关性最好(r=0. 827)。结论左室型单心室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估测左室型单心室的心功能,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 dominate chamber in single left ventricle (SLV) before and after cavopulmonary connection (Glenn) operation by three-dimensional speckle tracking echocardiography (3DSTE). Methods Seventeen patients with SLV 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 (EF) calculated by 3DSTE before and after Glenn palliation were compared with those measured by cardiac magnetic resonance (CMR). The volumes, EF, twist, torsion, and rotation were assessed in patients before and after operation and control group by 3DSTE and compared with each other. Results Compared to control group, the ejection fraction (55.567±3.577)% vs (63.628±3.739)%, twist (5.776±2.819)°vs (11.801±1.769)°, torsion (1.653±0.860)°/cm vs (3.123±0.490)°/cm, apical rotation (2.1 35±2.303)°vs (5.415±1.562)°, basal rotation (-3.672±1.751)° vs (-6.490±1.090)° were lower than healthy children,( P <0.01). After operation, the ejection fraction, twist, torsion, and basal rotation increased ( P <0.05). Basal rotation were significantly correlated with LVEF ( r =0.827). Conclusion SLV had impaired ventricular function, which was partially improved by palliation surgery to a certain extent. 3DSTE is a reliable and convenient clinical assessment tool for evaluation of ventricular function. Basal rotation may be good indicators for LV systolic function.