超声心动图在矫正型大动脉转位患儿二期双调转术中的应用价值

Application value of echocardiography in two-stage double switch in children with corrected transposition of the great arteries

目的 探讨超声心动图在矫正型大动脉转位(CTGA)患儿二期双调转术(DS)中的应用价值。方法 选取于外科行二期DS的17例CTGA患儿,分析超声心动图对其肺动脉环扎(PAB)术前诊断情况,比较PAB术前、后左心室形态及血流动力学情况;应用超声心动图观察DS术前、后左心室血流动力学变化。结果 17例CTGA患儿,PAB术前超声心动图准确诊断15例(88.24%);误诊2例(11.76%),均误诊为房室连接不一致型右心室双出口。PAB术后肺动脉内径、三尖瓣反流束宽均缩小,左心室舒张末期内径、左心室收缩末期内径、左心室后壁舒张末期厚度、室间隔舒张期厚度、左心室质量及肺动脉血流速度均明显增大,反流程度减轻,与PAB术前比较差异均有统计学意义(均P<0.05)。DS术后左心室心肌做功指数(MPI)明显增大,右心室MPI、左心室射血分数均明显减低,与DS术前比较差异均有统计学意义(均P<0.05);6例合并心功能不全(3例死亡,3例随访中)患儿中,室间隔完整3例,合并室间隔缺损3例(缺损直径分别为0.13 cm、0.15 cm、0.18 cm);11例心功能正常患儿室间隔缺损直径平均(0.37±0.18)cm。结论 超声心动图可准确诊断CTGA,CTGA患儿PAB术后左心室质量明显提高,可行DS;DS术后近期易合并心功能不全及主动脉瓣反流。

Objective To investigate the application value of echocardiography in two-stage double switch(DS)operation in children with corrected transposition of the great arteries(CTGA).Methods The echocardiography was used to analyze the preoperative diagnosis of pulmonary ring ligation(PAB)operation in 17 CTGA children with two-stage DS operation in the department of surgery.Left ventricular morphology and hemodynamics before and after PAB were compared.Left ventricular hemodynamics before and after DS operation were observed by echocardiography.Results Among 17 children with CTGA,15 cases(88.24%)were diagnosed correctly by echocardiography before PAB operation,2 cases(11.76%)were misdiagnosed as atrioventricular discordant connection double outlet of right ventricle.After PAB operation,the inner diameter of pulmonary artery and the width of tricuspid valve regurgitant bundle decreased,while the left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular posterior wall end-diastolic thickness,ventricular septal diastolic thickness,left ventricular mass and pulmonary artery flow velocity increased significantly,and the degree of regurgitant decreased,with statistical significance compared with those before PAB operation(all P<0.05).Left ventricular myocardial work index(MPI)increased significantly,right ventricular MPI and left ventricular ejection fraction decreased significantly after DS operation,with statistical significance compared with those of DS operation(all P<0.05).Among the 6 children with cardiac insufficiency(3 deaths,3 follow-up),the ventricular septum was intact in 3 cases,and the ventricular septal defect(diameter of 0.13 cm,0.15 cm,0.18 cm,respectively)in 3 cases.Among 11 children with normal cardiac function,the average diameter of ventricular septal defect was(0.37±0.18)cm.Conclusion CTGA could be diagnosed accurately by echocardiography,and the left ventricular mass of children with CTGA after PAB operation is significantly improved,which is feasible DS operation.Cardiac insufficiency and aortic regurgitation are common complications after DS operation.