摘要: |
目的 探讨评估左室退化的定量标准,分析影响左室训练效果的因素,评估动脉调转手术(ASO)效果。方法 收集于我院就诊的室间隔完整型完全性大动脉转位患儿86例,43例接受左室训练术和分期ASO,43例接受一期ASO。测量并计算左室前后径及其Z值、左室质量指数(LV mass指数)、左室压力退化率、LV mass指数退化率、左室与右室压力比值(LV/RV值)。结果 左室前后径Z值、LV mass指数与LV/RV值均呈强相关。判断分期ASO时机的最佳超声指标是LV mass指数,诊断临界值是59.7 g/m2,其次是LVEDd Z值,诊断临界值是-1.45,曲线下面积分别是 0.97、0.93,敏感性88.9%、88.9%,特异性97.4%、82.1%。43例接受左室训练术,10例(23.3%)在训练10 d内完成ASO,其余31例在训练后平均281.6 d完成ASO,另2例接受了2次肺动脉环缩术。回归分析左室退化程度与就诊年龄独立相关,就诊年龄为左室训练成功的唯一影响因素。结论 LV mass指数和左室前后径Z值可以判断心室压力比值,判断ASO手术时机。左室训练是安全的,可以为已经出现左室退化的室间隔完整型完全性大动脉转位患儿提供治疗机会。 |
关键词: 完全性大动脉转位 左室退化 左室训练术 动脉调转手术 |
DOI: |
投稿时间:2020-08-25修订日期:2021-03-05 |
基金项目:云南省阜外心血管病临床医学中心项目 |
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Assessment of Left Ventricular Function in Two-Staged Arterial Switch |
menghong |
(FuWai hospital, Chinese Academy of Medical Sciences) |
Abstract: |
Objective To explore the quantifiable parameters to evaluate left ventricular(LV)regression,to analyze the effect of retraining,and to assess the results of artery switch operation.Methods 86 patients with transposition of great artery with intact ventricular septum(TGA/IVS)were enrolled. LV retraining and the second stage arterial switch operation(ASO)were performed in 43 cases,while one-staged ASO were performed in other 43 patients. LV anterior-posterior diameter (LVEDd)and Z value,LV mass index,LV pressure regression ratio,LV mass regression ratio were measured.Results The Z value of LVEDd and LV mass index strongly correlated with the ratio of LV/RV pressure. The prior parameters to determine the timing of two-staged ASO were LV mass index with a cutoff value of 59.7 g/m2 and Z value of LVEDd with a cutoff value of -1.45,with area under curve of 0.97、0.93,sensitivity of 88.9%、88.9%,and specificity of 97.4%、82.1%. Among 43 patients undergoing LV retraining,10 patients underwent ASO within 10 days after training, 31 patients underwent ASO after a mean 281.6 days, the other 2 patients underwent pulmonary artery bandings twice. Age was an independent factor of LV regression degree and only influencing factor of successful LV retraining.Conclusion LV mass index and Z value of LVEDd could judge the ratio of LV/RV pressure,and determine the timing of ASO. LV retraining is safe and could provide the treatment opportunities for the TGA/IVS patients with LV regression. |
Key words: Transposition of great artery Left ventricular regression Left ventricular retraining Arterial switch operation |