三维超声心动图对法洛四联症患者术后右心室功能的评估
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摘要
目的:探讨实时三维超声心动图(RT-3DE)在评价法洛四联症(TOF)患者手术后右心室功能中的意义。方法:应用RT-3DE对23例TOF患者术前、术后6个月右心室收缩末期容积(RVESV)、右心室舒张末期容积(RVEDV)及右心室射血分数(RVEF)进行检测。并将TOF患者术后6个月的RVEF与心电图QRS间期进行相关分析。结果:与术前比较,TOF患者术后6个月RT-3DE所测RVEDV、RVESV无显著增加(P>0.05);RVEF明显减低(P<0.05)。TOF患者术后6个月RT-3DE超声所测RVEF与QRS间期呈负相关(r=-0.697, P<0.05)。结论:RT-3DE能准确评价TOF患者术后右心室功能,可以早期发现术后右心室功能不全,对TOF患者预后评估有重要意义。
Objective To explore the value of real-time three-dimensional echocardiography(RT-3 DE) in the evaluation of right ventricular function in patients after repair of tetralogy of Fallot(TOF). Methods The right ventricular end systolic volume(RVESV), right ventricular end diastolic volume(RVEDV) and right ventricular ejection fraction(RVEF) in 23 TOF patients before and 6 months after TOF repair were detected by RT-3DE. The correlation analysis was performed between RVEF and QRS interval of electrocardiogram which were obtained 6 months after the TOF repair. Results No significant increases were found in RVEDV and RVESV between preoperation and 6 months postoperation(P>0.05), while RVEF detected 6 months after TOF repair was significantly decreased(P<0.05). Six months postoperatively, RVEF detect by RT-3DE was found to be negatively correlated with QRS interval(r=-0.697, P<0.05). Conclusion RT-3 DE can accurately evaluate the right ventricular function in patients after TOF repair and achieve the early detection of postoperative right ventricular dysfunction, which is of great significance for the evaluation of the prognosis of TOF patients.
Objective To explore the value of real-time three-dimensional echocardiography(RT-3 DE) in the evaluation of right ventricular function in patients after repair of tetralogy of Fallot(TOF). Methods The right ventricular end systolic volume(RVESV), right ventricular end diastolic volume(RVEDV) and right ventricular ejection fraction(RVEF) in 23 TOF patients before and 6 months after TOF repair were detected by RT-3DE. The correlation analysis was performed between RVEF and QRS interval of electrocardiogram which were obtained 6 months after the TOF repair. Results No significant increases were found in RVEDV and RVESV between preoperation and 6 months postoperation(P>0.05), while RVEF detected 6 months after TOF repair was significantly decreased(P<0.05). Six months postoperatively, RVEF detect by RT-3DE was found to be negatively correlated with QRS interval(r=-0.697, P<0.05). Conclusion RT-3 DE can accurately evaluate the right ventricular function in patients after TOF repair and achieve the early detection of postoperative right ventricular dysfunction, which is of great significance for the evaluation of the prognosis of TOF patients.
引文
[1] DOWNING T E, KIM Y Y. Tetralogy of Fallot:general principles of management[J]. Cardiol Clin, 2015, 33(4):531-541.
[2] KOGON B E, ROSENBLUM J M, MORI M. Current readings:issues surrounding pulmonaryvalve replacement in repaired tetralogy of Fallot[J]. Semin Thorac Cardiovasc Surg, 2015, 27(1):57-64.
[3] SIMPSON J, LOPEZ L, ACAR P, et al. Three-dimensional echocardiography in congenital heart disease:an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography[J]. J Am Soc Echocardiogr, 2017, 30(1):1-27.
[4] MURPHY J G, GERSH B J, MAIR D D, et a1. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot[J]. N Engl J Med, 1993, 329(9):593-599.
[5] SABATE ROTES A, BONNICHSEN C R, REECE C L, et al. Longterm follow-up in repaired tetralogy of fallot:can deformation imaging help identify optimal timing of pulmonary valve replacement?[J]. J Am Soc Echocardiogr, 2014, 27(12):1305-1310.
[6] PILLA C B, PEREIRA C A, FIN A V, et a1. Health-related quality of life and right ventricular function in the midterm follow-up assessment after tetralogy of Fallot repair[J]. Pediatr Cardiol, 2008, 29(2):409-415.
[7] ABD EI RAHMAN M Y, HUI W, SCHUCK R, et al. Regional analysis of longitudinal systolic function of the right ventricle after corrective surgery of tetralogy of Fallot using myocardial isovolumetric acceleration index[J]. Pediatr Cardiol, 2013, 34(8):1848-1853.
[8] GEVA T, SANDWEISS B M, GAUVREAU K, et a1. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging[J]. J Am Cell Cardiol, 2004, 43(6):1068-1074.
[9] PADALINO M A, CAVALLI G, ALBANESE S B, et al. Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot[J]. J Card Surg, 2017, 32(11):712-720.
[10]FRIEDBERG M K, FERNANDES F P, ROCHE S L, et al. Impaired right and left ventricular diastolic myocardial mechanics and filling in asymptomatic children and adolescents after repair of tetralogy of Fallot[J]. Eur Heart J Cardiovasc Imaging, 2012, 13(11):905-913.
[11]张雁飞,王岳恒.超声心动图在肺动脉高压右心室功能评价中的应用[J].医学研究与教育, 2011, 28(2):85-88ZHANG Y F, WANG Y H. Application of echocardiography in the evaluation of right ventricular function of pulmonary hypertension[J].Medical Research and Education, 2011, 28(2):85-88
[12]陈思娟,陈国珍,吴兰平,等.实时三维超声评估儿童法洛四联症术后近期室间隔矛盾运动的发生及其影响因素分析[J].中华临床医师杂志(电子版), 2013, 7(13):5861-5864.SUN S J, CHEN G Z, WU L P, et al. Immediate postoperative paradoxical septal motion and influencing factor analysis by real-time three dimensional echocardiography in pediatric patients with tetralogy of Fallot[J]. Chinese Journal of Clinicians(Electronic Edition), 2013, 7(13):5861-5864.
[13]KUTTY S, ZHOU J, GAUVREAU K, et al. Regional dysfunction of the right ventricular outflow tract reduces the accuracy of Doppler tissue imaging assessment of global right ventricular systolic functionin patients with repaired tetralogy of Fallot[J]. J Am Soc Echocardiogr, 2011, 24(6):637-643.
[14]SIMPSON J, MILLER O, BELL A, et a1. Image orientation for three dimensional echocardiography of congenital heart disease[J]. Int J Cardiovasc Imaging, 2012, 28(4):743-753.
[15]PROMPHAN W, WONGLIKHITPANYA T, KATANYUWONG P, et al. A comparative study:right ventricular assessment in post-repaired tetralogy of Fallot patients by echocardiogram with cardiac magnetic resonance imaging[J]. J Med Assoc Thai, 2014, 97(Suppl 6):S232-S238.
[16]NAIR K K, GANAPATHI S, SASIDHARAN B, et a1. Asymptomatic right ventricular dysfunction in surgically repaired adult tetralogy of Fallot patients[J]. Ann Pediatr Cardiol, 2013, 6(1):24-28.
[17]ATSUMI A, SEO Y, ISHIZU T, et al. Right ventricular deformation analyses using a three-dimensional speckle-tracking echocardiographic system specialized for the right ventricle[J]. J Am Soc Echocardiogr, 2016, 29(5):402-411.
[18]KIM H, SUNG S C, KIM S H, et al. Early and late outcomes of total repair of tetralogy of Fallot:risk factors for late right ventricular dilatation[J]. Interact Cardiovasc Thorac Surg, 2013, 17(6):956-962.
[19]LU J C, COTTS T B, AGARWAL P P, et al. Relation of right ventricular dilation, age of repair, and restrictive right ventricular physiology with patient-reported quality of life in adolescents and adults with repaired tetralogy of Fallot[J]. Am J Cardiol, 2010, 106(12):1798-1802.
[20]BASSAREO P P, MERCURO G. QRS complex enlargement as a predictor of ventricular arrhythmias in patients affected by surgically treated tetralogy of Fallot:a comprehensive literature review and historical overview[J]. ISRN Cardiol, 2013:782508.
[21]BALAJI S, LAU Y R, CASE C L, et al. QRS prolongation is associated with inducible ventricular tachycardia after repair of tetralogy of Fallot[J]. Am J Cardiol, 1997, 80(2):160-163.
[2] KOGON B E, ROSENBLUM J M, MORI M. Current readings:issues surrounding pulmonaryvalve replacement in repaired tetralogy of Fallot[J]. Semin Thorac Cardiovasc Surg, 2015, 27(1):57-64.
[3] SIMPSON J, LOPEZ L, ACAR P, et al. Three-dimensional echocardiography in congenital heart disease:an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography[J]. J Am Soc Echocardiogr, 2017, 30(1):1-27.
[4] MURPHY J G, GERSH B J, MAIR D D, et a1. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot[J]. N Engl J Med, 1993, 329(9):593-599.
[5] SABATE ROTES A, BONNICHSEN C R, REECE C L, et al. Longterm follow-up in repaired tetralogy of fallot:can deformation imaging help identify optimal timing of pulmonary valve replacement?[J]. J Am Soc Echocardiogr, 2014, 27(12):1305-1310.
[6] PILLA C B, PEREIRA C A, FIN A V, et a1. Health-related quality of life and right ventricular function in the midterm follow-up assessment after tetralogy of Fallot repair[J]. Pediatr Cardiol, 2008, 29(2):409-415.
[7] ABD EI RAHMAN M Y, HUI W, SCHUCK R, et al. Regional analysis of longitudinal systolic function of the right ventricle after corrective surgery of tetralogy of Fallot using myocardial isovolumetric acceleration index[J]. Pediatr Cardiol, 2013, 34(8):1848-1853.
[8] GEVA T, SANDWEISS B M, GAUVREAU K, et a1. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging[J]. J Am Cell Cardiol, 2004, 43(6):1068-1074.
[9] PADALINO M A, CAVALLI G, ALBANESE S B, et al. Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot[J]. J Card Surg, 2017, 32(11):712-720.
[10]FRIEDBERG M K, FERNANDES F P, ROCHE S L, et al. Impaired right and left ventricular diastolic myocardial mechanics and filling in asymptomatic children and adolescents after repair of tetralogy of Fallot[J]. Eur Heart J Cardiovasc Imaging, 2012, 13(11):905-913.
[11]张雁飞,王岳恒.超声心动图在肺动脉高压右心室功能评价中的应用[J].医学研究与教育, 2011, 28(2):85-88ZHANG Y F, WANG Y H. Application of echocardiography in the evaluation of right ventricular function of pulmonary hypertension[J].Medical Research and Education, 2011, 28(2):85-88
[12]陈思娟,陈国珍,吴兰平,等.实时三维超声评估儿童法洛四联症术后近期室间隔矛盾运动的发生及其影响因素分析[J].中华临床医师杂志(电子版), 2013, 7(13):5861-5864.SUN S J, CHEN G Z, WU L P, et al. Immediate postoperative paradoxical septal motion and influencing factor analysis by real-time three dimensional echocardiography in pediatric patients with tetralogy of Fallot[J]. Chinese Journal of Clinicians(Electronic Edition), 2013, 7(13):5861-5864.
[13]KUTTY S, ZHOU J, GAUVREAU K, et al. Regional dysfunction of the right ventricular outflow tract reduces the accuracy of Doppler tissue imaging assessment of global right ventricular systolic functionin patients with repaired tetralogy of Fallot[J]. J Am Soc Echocardiogr, 2011, 24(6):637-643.
[14]SIMPSON J, MILLER O, BELL A, et a1. Image orientation for three dimensional echocardiography of congenital heart disease[J]. Int J Cardiovasc Imaging, 2012, 28(4):743-753.
[15]PROMPHAN W, WONGLIKHITPANYA T, KATANYUWONG P, et al. A comparative study:right ventricular assessment in post-repaired tetralogy of Fallot patients by echocardiogram with cardiac magnetic resonance imaging[J]. J Med Assoc Thai, 2014, 97(Suppl 6):S232-S238.
[16]NAIR K K, GANAPATHI S, SASIDHARAN B, et a1. Asymptomatic right ventricular dysfunction in surgically repaired adult tetralogy of Fallot patients[J]. Ann Pediatr Cardiol, 2013, 6(1):24-28.
[17]ATSUMI A, SEO Y, ISHIZU T, et al. Right ventricular deformation analyses using a three-dimensional speckle-tracking echocardiographic system specialized for the right ventricle[J]. J Am Soc Echocardiogr, 2016, 29(5):402-411.
[18]KIM H, SUNG S C, KIM S H, et al. Early and late outcomes of total repair of tetralogy of Fallot:risk factors for late right ventricular dilatation[J]. Interact Cardiovasc Thorac Surg, 2013, 17(6):956-962.
[19]LU J C, COTTS T B, AGARWAL P P, et al. Relation of right ventricular dilation, age of repair, and restrictive right ventricular physiology with patient-reported quality of life in adolescents and adults with repaired tetralogy of Fallot[J]. Am J Cardiol, 2010, 106(12):1798-1802.
[20]BASSAREO P P, MERCURO G. QRS complex enlargement as a predictor of ventricular arrhythmias in patients affected by surgically treated tetralogy of Fallot:a comprehensive literature review and historical overview[J]. ISRN Cardiol, 2013:782508.
[21]BALAJI S, LAU Y R, CASE C L, et al. QRS prolongation is associated with inducible ventricular tachycardia after repair of tetralogy of Fallot[J]. Am J Cardiol, 1997, 80(2):160-163.