超声心动图对低龄患儿主动脉瓣狭窄瓣膜成形术的评价

发布时间：2018-03-29 04:21

本文选题：超声心动图　切入点：主动脉瓣成形术　出处：《中国循环杂志》2015年09期

【摘要】：目的 :应用超声心动图评价因先天性主动脉瓣狭窄接受主动脉瓣成形术(AVP)低龄患儿的心脏结构及血流动力学特点,探讨超声心动图在先天性主动脉瓣成形术中的临床价值。方法 :回顾分析39例因先天性主动脉瓣狭窄在我院接受主动脉瓣成形术的低龄患儿(年龄中位数23个月)的超声心动图资料。将超声主要指标在术前、术后1周、1~3个月及6~12个月四个时间段的变化进行统计学分析。结果 :本研究中主动脉瓣分叶二叶与三叶比例约5.5:1,围术期共2例死亡。手术前、术后1周、1~3个月及6~12个月后经胸超声测量数据相比较,术后各时间段主动脉瓣峰值流速(Vmax)及平均跨瓣压差(MPG)均较术前减低[Vmax:(4.30±0.73)m/s,(2.65±0.78)m/s,(2.93±0.63)m/s,(3.01±0.83)m/s,P0.01];[MPG:(45.78±15.19)mm Hg(1 mm Hg=0.133 k Pa),(18.24±10.08)mm Hg,(21.01±10.08)mm Hg,(22.31±13.41)mm Hg,P0.01];术后各时间较术前左心室射血分数(LVEF)无明显变化;左心室舒张末径(LVEDD)术后6~12个月较术后1周增加(P0.05);相对室壁厚度(RWT)术后6~12个月较术前及术后1周减低(P0.05);主动脉瓣反流(AR)术后6~12个月较术前增加(P0.01)。Pearson相关性分析显示主动脉瓣环内径(AA)与LVEDD呈正相关(r=0.648,P0.01),AA与Vmax呈负相关(r=-0.205,P0.05),RWT与Vmax呈正相关(r=0.196,P0.05)。患儿中术前LVEF减低的6例,除1例死亡外,其余5例术后6~12个月时LVEF较术前有所提高(P0.05)。结论 :超声心动图可作为先天性主动脉瓣狭窄的首选影像诊断方法,在AVP术前诊断、术中监测及术后评价方面发挥重要价值。
[Abstract]:Objective: to evaluate the cardiac structure and hemodynamic characteristics of young children with congenital aortic valve stenosis receiving AVP by echocardiography. To explore the clinical value of echocardiography in congenital aortic valvuloplasty. Methods: a retrospective analysis of 39 young children (median age 23) with congenital aortic valve stenosis in our hospital. The main indexes of echocardiography were measured before operation. Results: in this study, the ratio of the two lobes to the trefoil of aortic valve was about 5.5: 1, and 2 cases died in perioperative period. After 1 week, 1 ~ 3 months and 6 ~ 12 months after operation, the data measured by transthoracic ultrasound were compared. The peak aortic valve velocities (Vmax) and the mean transvalvular pressure difference (MPGs) were significantly lower than those before the operation [Vmax:(4.30 卤0.73 卤0.78 m / s / s Vmax:(4.30 2.93 卤0.63 卤0.63 m / s / s]; [MPG:(45.78 卤15.19)mm Hg(1 mm Hg=0.133 k pressure > 18.24 卤10.08)mm Hg(1 Hg=0.133 21.01 卤10.08)mm Hgn 22.31 卤13.41)mm Hgt P0.01], but there was no significant difference between the postoperative time and the preoperative left ventricular ejection fraction (LVEF). Left ventricular end-diastolic diameter (LVEDDD) increased P0.05 after 6 ~ 12 months compared with 1 week after operation, relative wall thickness of RWT6 ~ 12 months was lower than that of preoperative and postoperative 1 week, and aortic valve reflux (ARA) increased P0.01.Pearson correlation analysis of 6 ~ 12 months after operation compared with preoperative. The diameter of annulus arteriosus was positively correlated with LVEDD. There was a negative correlation between AA and Vmax. There was a positive correlation between RWT and Vmax. 6 cases had decreased LVEF before operation. In addition to one death, LVEF in 5 cases was significantly higher than that before operation in 6 ~ 12 months after operation (P 0.05). Conclusion: echocardiography can be used as the preferred imaging diagnosis method for congenital aortic valve stenosis, and it can be used to diagnose the congenital aortic valve stenosis before AVP. Intraoperative monitoring and postoperative evaluation play an important role.
【作者单位】：北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院超声影像中心;北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院小儿外科中心;
【基金】：国家自然科学基金资助项目(81271583)
【分类号】：R540.45;R725.4

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