超声心动图球形指数评价左冠状动脉异常起源于肺动脉手术后左心室构型的变化

Echocardiographic spherical index to evaluate the changes of left ventricular configuration after anomalous origin of left coronary artery from pulmonary artery operation

背景左冠状动脉异常起源于肺动脉(ALCAPA)是一种罕见但危及生命的先天性心脏病,可导致左心室构型改变并影响左心室功能。因此,对ALCAPA患儿手术前后的左心室构型进行评估非常必要。目的采用超声心动图球形指数(SI)对ALCAPA患儿手术前后左心室构型的变化进行评价。设计病例对照研究。方法纳入经超声心动图诊断为单纯婴儿型ALCAPA且行左冠状动脉移植手术并在手术前后1周行超声心动图检查的连续患儿。以因体格检查而行超声心动图检查的儿童为正常对照。比较ALCAPA患儿手术前后以及正常对照儿童的SI和左室射血分数(LVEF),对其左心室构型和左心室收缩功能进行评价。主要结局指标ALCAPA手术前后左心室构型的变化。结果2006年2月至2021年10月纳入病例15例,平均月龄(7.5±6.6)。ALCAPA手术前和后左心室舒张末期球形指数(SI_(d))分别为1.22±0.11和1.42±0.15。正常对照组15例,平均月龄(7.4±6.6),左心室SI_(d)为1.49±0.15,P<0.01,ALCAPA手术前和后左心室收缩末期球形指数(SI_(s))分别为1.35±0.17和1.54±0.17,正常对照组左心室SI_(s)为1.55±0.15,P<0.01。ALCAPA手术前和后LVEF分别为(44.7±13.8)%和(63.9±13.8)%,P<0.01。手术前左心室SI_(s)与LVEF具有相关性(P>0.01)。结论超声心动图SI可用于评价ALCAPA患儿手术前后左心室的构型变化。ALCAPA患儿手术前左心室呈球形化改变,手术后左心室重构、构型改善。

Background Anomalous origin of left coronary artery from pulmonary artery(ALCAPA)is a rare but life⁃threatening congenital heart disease which can lead to changes in left ventricular configuration and affect left ventricular function.Therefore,it's necessary to evaluate the left ventricular configuration of the patients with ALCAPA before and after the surgical operation.Objective To evaluate the changes of left ventricular configuration in patients with ALCAPA before and after the operation by echocardiographic spherical index(SI).Design Case⁃control study.Methods Consecutive simple infantile ALCAPA patients diagnosed by echocardiography were enrolled who underwent left coronary artery transplantation and received echocardiography 1 week before and after the operation.Children receiving echocardiography because of the physical examination were taken as the normal controls.The pre⁃and post⁃operative ALCAPA patients and the normal control group were measured by SI and left ventricular ejection fraction(LVEF)derived by echocardiography to evaluate the left ventricular configuration and left ventricular systolic function.Main outcome measures Changes of left ventricular configuration before and after ALCAPA operation.Results From February 2006 to October 2021,a total of 15 patients with simple infantile ALCAPA aged 7.5±6.6 months were included.In the group of ALCAPA patients,the pre⁃operative and post⁃operative left ventricular SI_(d) was 1.22±0.11 and 1.42±0.15,and the pre⁃operative and post⁃operative left ventricular SI_(s) was 1.35±0.17 and 1.54±0.17,respectively.In the control group with the average age of 7.4±6.6 months for 15 patients,the left ventricular SI_(d) and SI_(s) was 1.49±0.15 and 1.55±0.15,respectively.In the group of ALCAPA patients,the pre⁃operative and post⁃operative LVEF was(44.7±13.8)%and(63.9±13.8)%(P<0.01).There was a correlation between left ventricular SI_(d),SI_(s) and LVEF before the operation(P>0.01).Conclusion SI derived by echocardiography can be used to evaluate the changes of left ventricular configuration in patients with ALCAPA before and after the operation.In patients with ALCAPA,the left ventricular spheroidization was distinct before the operation,and the left ventricular remodeling and configuration were improved after operation.