Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited eviden...Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients＇ follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation（SpO_2）, 6-minute walk test（6 MWT）, superior vena cava pressure（SVCP）, pulmonary arterial pressure（PAP）, pulmonary capillary wedge pressure（PCWP）, pulmonary vascular resistance（PVR）, small pulmonary vascular resistance（s PVR） were measured. Pre-and post-total cavopulmonary connection（TCPC） SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic（ROC） curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery（75.42 ± 9.62% to 86.98 ± 7.63%, P 〈 0.001） from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%（P 〈 0.001）. The △SpO_2 and 6-minute walk distance（6 MWD） in the 32 who underwent TCPC and ten of them did not reach statistical significance（17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure（s RPAP）, mean right pulmonary artery pressure（m RPAP）, mean left pulmonary artery pressure（m LPAP）, PVR, and s PVR were significantly lower in the TCPC group than in the non-TCPC group. The differences in superior vena cava systolic blood pressure（s SVCP）, mean superior vena cava pressure（m SVCP）, and left pulmonary artery systolic pressure（s LPAP） were not significant. The optimal cutoff values for TCPC were s SVCP ≤ 20 mm Hg（P = 0.025）,s RPAP ≤ 22 mm Hg（P = 0.0001, mRPAP ≤ 13 mm Hg（P =0.003）, s LPAP ≤ 27 mm Hg（P =0.03）, m LPAP ≤ 11 mm Hg（P = 0.01）, PVR ≤ 4.3 Wood U/m^2（P 〈0.0001） and were significantly associated with TCPC selection,except for m SVCP ≤ 19 mm Hg（P = 0.06） and s PVR ≤ 2.0 wood U/m^2（P = 0.0531）. One patient died because of low cardiac output after TCPC. In-hospital mortality was 2.1%. Conclusion The SpO_2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery. The 6 MWT is an index of activity tolerance prior toTCPC. Hemodynamic values of s SVCP ≤ 20 mm Hg, s RPAP ≤ 22 mm Hg, m RPAP ≤ 13 mm Hg, s LPAP ≤ 27 mm Hg, m LPAP ≤ 11 mm Hg, and PVR ≤ 4.3 Wood U/m^2 can help identify post Glenn-shunt patients indicated for TCPC.展开更多
目的探讨3.0 T MRI SE序列结合电影成像诊断复杂先天性心脏病(CCHD)双向Glenn分流术(BGS)后心脏畸形、主心室和房室瓣功能的价值。资料与方法采用Triple-IR和快速稳态平衡进动序列(FIESTA)对22例BGS术后患者进行心脏检查,用Report Card...目的探讨3.0 T MRI SE序列结合电影成像诊断复杂先天性心脏病(CCHD)双向Glenn分流术(BGS)后心脏畸形、主心室和房室瓣功能的价值。资料与方法采用Triple-IR和快速稳态平衡进动序列(FIESTA)对22例BGS术后患者进行心脏检查,用Report Card软件分析心脏畸形、主心室和房室瓣功能,应用配对样本t检验分析MRI测量主心室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)及轴缩短率(FS)与超声心动图(UCG)测量相应指标的差异性和相关性;应用Spearman等级相关对电影MRI测量的房室瓣返流程度与UCG进行检验分析。结果 Triple-IR结合FIESTA能清楚显示心内畸形和心脏大血管连接部畸形;3.0 T MRI测量EDV、ESV、EF及FS与UCG测量值之间差异无统计学意义,两者相关性良好(r=0.727～0.990);电影MRI测量房室瓣返流程度与UCG呈显著正相关(rs=0.712),两者吻合度较好(Kappa=0.453,P=0.01)。结论 3.0 T MRI SE序列结合电影成像能全面显示BGS术后患者复杂心内畸形和心脏大血管连接关系,评价主心室和房室瓣功能与UCG相关性良好。展开更多
基金funded by the grants from the National Key R&D Program of China(No.2016YFC1100300)the Guangdong Science and Technology Project,China(No.2015B070701008)
文摘Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients＇ follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation（SpO_2）, 6-minute walk test（6 MWT）, superior vena cava pressure（SVCP）, pulmonary arterial pressure（PAP）, pulmonary capillary wedge pressure（PCWP）, pulmonary vascular resistance（PVR）, small pulmonary vascular resistance（s PVR） were measured. Pre-and post-total cavopulmonary connection（TCPC） SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic（ROC） curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery（75.42 ± 9.62% to 86.98 ± 7.63%, P 〈 0.001） from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%（P 〈 0.001）. The △SpO_2 and 6-minute walk distance（6 MWD） in the 32 who underwent TCPC and ten of them did not reach statistical significance（17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure（s RPAP）, mean right pulmonary artery pressure（m RPAP）, mean left pulmonary artery pressure（m LPAP）, PVR, and s PVR were significantly lower in the TCPC group than in the non-TCPC group. The differences in superior vena cava systolic blood pressure（s SVCP）, mean superior vena cava pressure（m SVCP）, and left pulmonary artery systolic pressure（s LPAP） were not significant. The optimal cutoff values for TCPC were s SVCP ≤ 20 mm Hg（P = 0.025）,s RPAP ≤ 22 mm Hg（P = 0.0001, mRPAP ≤ 13 mm Hg（P =0.003）, s LPAP ≤ 27 mm Hg（P =0.03）, m LPAP ≤ 11 mm Hg（P = 0.01）, PVR ≤ 4.3 Wood U/m^2（P 〈0.0001） and were significantly associated with TCPC selection,except for m SVCP ≤ 19 mm Hg（P = 0.06） and s PVR ≤ 2.0 wood U/m^2（P = 0.0531）. One patient died because of low cardiac output after TCPC. In-hospital mortality was 2.1%. Conclusion The SpO_2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery. The 6 MWT is an index of activity tolerance prior toTCPC. Hemodynamic values of s SVCP ≤ 20 mm Hg, s RPAP ≤ 22 mm Hg, m RPAP ≤ 13 mm Hg, s LPAP ≤ 27 mm Hg, m LPAP ≤ 11 mm Hg, and PVR ≤ 4.3 Wood U/m^2 can help identify post Glenn-shunt patients indicated for TCPC.
文摘目的探讨3.0 T MRI SE序列结合电影成像诊断复杂先天性心脏病(CCHD)双向Glenn分流术(BGS)后心脏畸形、主心室和房室瓣功能的价值。资料与方法采用Triple-IR和快速稳态平衡进动序列(FIESTA)对22例BGS术后患者进行心脏检查,用Report Card软件分析心脏畸形、主心室和房室瓣功能,应用配对样本t检验分析MRI测量主心室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)及轴缩短率(FS)与超声心动图(UCG)测量相应指标的差异性和相关性;应用Spearman等级相关对电影MRI测量的房室瓣返流程度与UCG进行检验分析。结果 Triple-IR结合FIESTA能清楚显示心内畸形和心脏大血管连接部畸形;3.0 T MRI测量EDV、ESV、EF及FS与UCG测量值之间差异无统计学意义,两者相关性良好(r=0.727～0.990);电影MRI测量房室瓣返流程度与UCG呈显著正相关(rs=0.712),两者吻合度较好(Kappa=0.453,P=0.01)。结论 3.0 T MRI SE序列结合电影成像能全面显示BGS术后患者复杂心内畸形和心脏大血管连接关系,评价主心室和房室瓣功能与UCG相关性良好。
