先天性心脏病术后右心功能影像学评估研究进展

Research Progress of Postoperative Right Ventricle Function by Imaging Evaluation in Congenital Heart Disease

右心功能恢复是维持心脏病术后患者循环稳定的关键,也是复杂先天性心脏病二期手术时期的重要参考因素。但右心室的复杂几何形态和室壁运动对右心功能的无创评估造成一定困难。心脏磁共振(CMR)是常用影像学方法中的“金标准”,复杂先天性心脏病术后需定期做CMR检查。CMR新技术的应用主要包括4D flow血流动力学测量、定量成像和示踪技术,根据心肌损伤程度评估右心室功能。超声心动图是应用最广的一线影像学检查,适用于所有先天性心脏病术后心功能评估,超声斑点追踪技术的发展已更加成熟。心脏计算机断层扫描评估血管和累及肺部病变具有突出优势,常作为CMR的替代方案。人工智能在图像处理技术的发展大幅度提升了影像学检查的诊断和预测价值。本文对CMR、超声心动图和心脏计算机断层扫描的特点和评估先天性心脏病术后右心功能的研究进展进行综述。

The restoration of right ventricle dysfunction is essential to the maintenance of systemic circulation in patients after cardiac surgery.It also plays a significant part in planning surgical repair following the last stage of surgical palliation.Nevertheless,the complex geometry and wall motion of the right ventricle make it difficult to evaluate the right ventricle function with the noninvasive tools.Cardiac magnetic resonance(CMR)is the gold standard of the most commonly used technology for cardiac imaging,which is necessary to be involved in regular surveillance for patients undergoing complicated cardiac surgery.The application of new CMR technology mainly includes 4D flow hemodynamic measurement,MRI mapping and tracking technology to evaluate the right ventricular function by detecting the myocardial injury.Echocardiography is the first-line method of postoperative assessment and appropriate for all kinds of congenital heart disease.Speckle-tracking echocardiography has been further development in recent years.Cardiac computed tomography has prominent advantages in detecting the vessels and pulmonary lesions,which is often used as an alternative to MRI.The development of artificial intelligence in image processing technology has greatly improved the diagnostic and predictive value of imaging examination.By comparing the characteristics of CMR,echocardiography and cardiac computed tomography,this paper reviews the research progress of these three imaging methods in the evaluation of the postoperative right ventricle function in congenital heart disease.