超声评估儿童右心室流出道重建围手术期右心收缩功能变化及临床价值探讨

Perioperative right ventricular systolic functional assessment of pediatric right ventricular outflow tract reconstruction surgery with echocardiography and its clinical value analysis

目的对行右心室流出道重建术的圆锥动脉干畸形患儿围手术期右心总体及节段收缩功能进行超声评估,并探讨几种超声测量指标变化的临床价值及意义。方法应用实时三维超声(RT3DE)、二维超声(2DE)及M型超声(M-Echo)对40例行右心室流出道重建术的圆锥动脉干畸形患儿术前、术后2～3d进行右心收缩功能评估,并比较手术前、后RT3DE所测右心舒张末容积(3D-RVEDV)、收缩末容积(3D-RVESV)及射血分数(3D-RVEF)、右心室心尖四腔切面面积变化率(RV-4FAC)、右心室两腔切面面积变化率(RV-2FAC)、三尖瓣瓣环收缩期位移(TAPSE)及舒张末期右心室游离壁心肌厚度(RVWT)等指标,分析各指标变化的临床价值和意义。结果与术前相比,术后2～3d3D-RVEDV、3D-RVEF、RV-2FAC及TAPSE均显著降低(P<0.001),而3D-RVESV、RV-4FAC无明显变化,术后RVWT较术前显著增加。术前RV-2FAC与RV-4FAC测值无显著差异,术后RV-2FAC较RV-4FAC降低。结论 3D-RVEF、RV-2FAC及TAPSE是反映右心室流出道重建术围手术期右心收缩功能的敏感指标。右心室流出道重建术后右心室总体、右心室流出道、游离壁长轴方向运动功能均受累,其中右心室流出道收缩功能异常对右心总体收缩功能影响较大。

Objective To assess perioperative right ventricular whole and regional systolic function of conotruncal heart defects in pediatric patients who went through the right ventricular outflow tract reconstruction surgery with echocardiography,and analyze the clinical value of the echocardiographic parameters.Methods In 40 pediatric patients of conotruncal heart defects,the right ventricular systolic functional parameters before and two or three days after the right ventricular outflow tract reconstruction surgery were measured and assessed by real-time three dimensional echocardiography(RT3DE),two-dimensional echocardiography(2DE)and M-mode echocardiography(M-Echo),including right ventricular end diastolic volume(3D-RVEDV),end systolic volume(3DRVESV)and ejection fraction(3D-RVEF),right ventricular fractional area change in apical four chamber view(RV-4FAC)and apical two chamber view(RV-2FAC),tricuspid annular plane systolic excursion(TAPSE),as well as the right ventricular free wall thickness in the end diastolic period(RVWT).Changes of perioperative right ventricular systolic function were clarified by comparing these preoperative and postoperative parameters using T test,their clinical value was then analyzed.Intra-and inter-observer variability of these parameters were calculated to assess the measurement reproducibility.Results Compared with the preoperative measurements,in two or three days after the surgery the post-operative measurements of RVEDV,RVEF,RV-2FAC and TAPSE were significantly reduced,at the same time,RVWT was increased,whereas RV-4FAC and RVESV were not changed significantly.In addition,RV-4FAC and RV-2FAC didn't show any significant difference during the preoperative period,whereas RV-2FAC was reduced compared with RV-4FAC postoperatively.Conclusions 3D-RVEF,RV-2FAC,TAPSE are three sensitive parameters to reflect the perioperative right ventricular systolic function of right ventricular outflow tract reconstruction surgery.After the surgery,both the whole and regional right ventricular systolic function such as the longitudinal myocardial movement of right ventricular free wall and right ventricular outflow tract movement are impaired.Right ventricular outflow tract dysfunction might be the more important factor for right ventricular whole systolic functional impairment.