| 摘要: |
| 目的 观察肺动脉环扎(pulmonary artery banding,PAB)对矫正型大动脉转位(corrected transposition of the great arteries, CTGA)患者左心室血流动力学的影响,评价超声心动图在二期双调转术(double switch,DS)手术时机判断中的作用。方法 17例室间隔完整或合并限制性室间隔缺损的CTGA患儿,行PAB锻炼左心室心肌,然后行DS。应用超声心动图观察左心室各指标的变化。结果 17例CTGA患儿,术前超声诊断正确15例,占88.24%；误诊2例,占11.76%；2例均误诊为房室连接不一致型右室双出口。PAB术后左心室质量指数从(33.56±12.58)g/m2上升至(66.72±12.28)g／m2(P <0.01)。PAB术后(2.71±1.85)年行DS,术后6例合并心功能不全,其中3例死亡,3例随访中；10例患者术后出现不同程度的主动脉瓣反流；三尖瓣反流束宽度从术前(0.49±0.25)cm下降到术后(0.21±0.15)cm,P <0.05。6例心功能不全患者3例室间隔完整,3例合并室间隔缺损(大小分别为0.13cm、0.15cm、0.18cm)；而11例心功能正常患者室间隔缺损大小(0.37±0.18)cm。结论 超声心动图术前可以比较准确地诊断CTGA,PAB术后左心室质量明显增加,可行二期DS；室间隔完整及合并限制性室间隔缺损者二期DS术后近期容易合并心功能不全及主动脉瓣反流,远期效果尚需要进一步研究。 |
| 关键词: 矫正型大动脉转位 双调转术 肺动脉环扎 超声心动图 |
| DOI： |
| 投稿时间：2023-11-12修订日期：2023-12-07 |
| 基金项目:国家自然科学基金青年基金(82001835) |
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| Study on the application value of echocardiography in two-stage double switch procedure for corrected transposition of the great arteries |
| WU Lijun,LIU Yiman,ZHANG Yuqi,DONG Yi,CHEN Lijun |
| (Department of Echocardiography,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University) |
| Abstract: |
| Study on the application value of echocardiography in two-stage double switch procedure for corrected transposition of the great arteries
WU Lijun, LIU Yiman，ZHANG Yuqi，DONG Yi，CHEN Lijun
Department of Echocardiography, Xinhua Hospital, School of Medicine，Shanghai Jiaotong University，Shanghai 200092, China
ABSTRACT Objective To review the changes of left ventricular hemodynamic after pulmonary artery banding (PAB) and evaluate the role of echocardiography in surgical decision making in two-stage double switch (DS) for corrected transposition of the great arteries (CTGA). Methods
Seventeen children with CTGA underwent pulmonary artery banding to prepare the left ventricle
基金项目：国家自然科学基金青年基金（82001835）
作者单位：200092 上海市，上海交通大学医学院附属新华医院超声室(吴力军、董怡)；上海交通大学医学院附属上海儿童医学
中心心内科(刘贻曼、张玉奇、陈丽君)
通讯作者：张玉奇，changyuqi6812@163.com
for two-stage DS．Doppler echocardiography was performed in the interval phase to assess left ventricular changes. Results In 17 children, 15 cases were diagnosed correctly (88.24%), 2 cases (11.76%) were misdiagnosed as atrioventricular discordant connection double outlet of right ventricle. The mean interval between PAB and DS was (2.71±1.85) years, left ventricular mass index before pulmonary artery banding was (33.56±12.58)g/m2 and increase to (66.72±12.28)g/m2，P<0.01. After two-stage double switch，the severity of tricuspid regurgitation was relieved (0.49±0.25cm vs 0.21±0.15cm，P<0.05). Heart dysfunction was found in 6 cases（35.29％）, including 3 cases died and 3 case follow-up. In these 6 cases, 3 cases with intact ventricular septum, 3 cases with restrictive ventricular septal defects, the diameter of ventricular septal defect was 0.13cm、0.15cm、0.18cm；in 11 cases with normal heart function, the diameter of ventricular septal defect was (0.37±0.18)cm. Conclusions CTGA could be diagnosed accurately by echocardiography，two-stage DS is applicable for CTGA with intact ventricular septum or restrictive ventricular septal defect, heart dysfunction and aortic valve regurgitation were common and long-term effect was need to make further study.
KEY WORDS Corrected transposition of the great arteries；Double switch；pulmonary artery banding; Echocardiography |
| Key words: Corrected transposition of the great arteries Double switch pulmonary artery banding Echocardiography |
