Doppler echocardiographic evaluation of left ventricular configuration and function in children with pulmonary artery hypertension secondary to congenital heart disease
CUI Hua, FAN Li, FENG Zhi-Chun
Department of Cardiology, General Hospital of People's Liberation Army, Beijing 100853, China.
摘要 目的：探讨多普勒超声心动图对先天性心脏病（CHD）儿童肺动脉高压（PAH）的诊断价值及PAH对左室重塑和舒张功能（LVDF）的影响。方法：对彩色多普勒超声心动图证实的45例继发肺动脉高压的先天性心脏病患儿的超声心动图和多普勒血流资料与22例无PAH的先天性心脏病患儿（对照组）对比分析。结果：PAH组及对照组的左室舒张末内径分别为18.24±1.71 mm vs 16.28±0.52 mm、右室内径 12.23±2.14 mm vs 8.14±0.73 mm、肺动脉内径 11.20±1.35 mm vs 7.92±0.21 mm。两组比较差异有显著性（P<0.05）；VTR 流速增快（2.56±0.46）m/s及PASP压力（40.23±4.56）mmHg升高 ，与对照组相比差异亦有显著性（P<0.05）；室间隔增厚与对照组相比差异不明显。对照组、PAH组的二尖瓣口血流多普勒频谱A峰流速分别为94.56±31.45 m/s vs 51.17±26.67 m/s、A峰流速速度时间积分为10.89±2.73 s vs 4.94±1.85 s及AV/EV为1.79±0.32 vs 0.59±0.19、AVTI/EVTI为1.61±0.49 vs 0.45±0.21 两组比较差异有显著性(P<0.01)。左室等容舒张时间分别为119. 86±54.62 s vs 52.31±28.06 s。PAH组明显延长(P<0.05)。E峰流速、E峰流速速度时间积分及E峰减速时间两组无明显改变(P>0.05)。而增高的肺动脉压与二尖瓣口血流频谱AV/EV比值呈正相关,相关系数 r=0.4 456， P<0.01。结论：多普勒超声心动图不仅是先天性心脏病儿童合并肺动脉高压最重要的诊断方法之一，还可提供肺动脉高压对左室重塑和舒张功能受损的指标，对临床判断病情轻重及预后有重要价值。［中国当代儿科杂志，2007，9（5）：422-424］
Abstract：OBJECTIVE: To evaluate the value of Doppler echocardiography in the diagnosis of pulmonary artery hypertension (PAH) and the effect of PAH on left ventricular remodelling and diastolic function using Doppler echocardiography in children with congenital heart disease (CHD). METHODS: Doppler echocardiography was performed on 45 CHD children with PAH (PAH group) and the results were compared with those of 22 CHD children with normal pulmonary artery pressure (control group). RESULTS: Doppler echocardiography showed that the diameter of end-diastolic left ventricular (18.24±1.71 mm vs 16.28±0.52 mm), the diameter of right ventricular (12.23±2.14 mm vs 8.14±0.73 mm), and the pulmonary artery diameter (11.20±1.35 mm vs 7.92±0.21 mm ) increased significantly in the PAH group compared with those in the control group (P< 0.05). The PAH group had higher velocity of tricuspid valve regurgitation (2.56±0.46 m/s) and higher pulmonary artery pressure (40.23±4.56 mmHg) than the control group (P< 0.05). The PAH group had also higher mitral peak A velocity (AV, 94.56±31.45 m/s vs 51.17±26.67 m/s), higher mitral AV velocity-time intergrate (10.89±2.73 s vs 4.94±1.85 s), higher ratio of mitral AV to mitral peak E velocity (EV) (1.79±0.32 vs 0.59±0.19) and higher ratio of mitral velocity-time intergrate of AV/EV (1.61±0.49 vs 0.45±0.21) than the control group. The left ventricular isovolumetric relaxation time (119.86±54.62 s vs 52.31±28.06 s) was prolonged in the PAH group (P< 0.05). In the PAH group, there was a positive correlation between the increased pulmonary artery pressure and the ratio of mitral AV/EV (r=0.4456, P< 0.01). CONCLUSIONS: Doppler echocardiography is not only an important non-invasive diagnostic technique for PAH in children with CHD, but also a tool which can indicate the left ventricular remodelling and diastolic dysfunction induced by PAH. It is useful to evaluate the severity and the prognosis of PAH secondary to CHD.
CUI Hua,FAN Li,FENG Zhi-Chun. Doppler echocardiographic evaluation of left ventricular configuration and function in children with pulmonary artery hypertension secondary to congenital heart disease[J]. CJCP, 2007, 9(5): 422-424.
