肺静脉血流评价小儿先天性心脏病左心室舒张功能

Doppler pulmonary venous flow in left ventricular diastolic function in children with congenital heart disease

目的 探讨肺静脉血流方法评价先天性心脏病 (先心病 )患儿左心室舒张功能的应用价值。方法 3 5例患病组于术前 1周内及术后 1个月应用肺静脉血流频谱评价左室舒张功能并与二尖瓣口血流方法比较 ,同时与 3 7例正常对照组进行对比研究。患病组据心室负荷分左心型和右心型。结果 左心型术前D波增高 ,S/D与TS/TD比值下降 ,术后S波D波速度较术前明显降低 ,S/D比值增加 ,TS增加 ,TD减低 ,TS/TD比值增加。右心型术前S波增高 ,S/D比值增高 ,TS/TD比值下降 ,术后D波速度增加 ,S/D比值减低 ,TS/TD比值增加。患病组中 71%二尖瓣口血流E/A比值正常 ,其中 92 %通过肺静脉血流频谱TS/TD比值异常检测出左室舒张功能异常 ,5 6%肺静脉血流频谱S/D比值异常。结论 肺静脉血流方法是评价先心病患儿术前左室舒张功能的可靠方法 ,可鉴别二尖瓣血流E/A比值假性正常。

Objective To evaluate the value of pulmonary venous flow in assessment of left ventricular diastolic function (LVDF) in children with congenital heart disease.Methods Thirty-five patients and thirty-seven age-matched healthy children were studied respectively by pulmonary venous flow. The patients were divided into two groups according to the ventricular load.Results Before operation in GroupⅠ(left ventricular overload):peak velocity of D increased,the ratio of S/D and TS/TD were lower significantly than those of the normal control group. One month after operation,peak velocity of S and D decreased and the ratio of S/D,TS/TD increased. Before operation in GroupⅡ(right ventricular overload):peak velocity of S increased and the ratio of S/D was higher than those of the normal control group while the ratio of TS/TD was lower. One month after operation,peak velocity of D increased and the ratio of S/D was lower while TS/TD was higher. 71% of the patients were with normal spectral of transmitral flow (1<E/A<2).Among them,92% patients had left ventricular diastolic dysfunction (LVDD) detected through abnormal TS/TD ratio and 56% detected through abnormal S/D ratio of pulmonary venous flow.Conclusion Pulmonary venous flow was a reliable method in assessment of LVDF in children with congenital heart disease,which could distinguish false normalized E/A ration of the mitral vale.