先天性心脏病肺动脉高压患儿左室舒张功能与血浆脑利钠水平的相关性研究

目的：探讨先天性心脏病 (CHD)合并肺动脉高压 (PAH) 患儿脑利钠肽（BNP）水平及与左室舒张功能的关系。方法：对95例CHD继发有PAH的患儿和42例无PHA的CHD患儿（对照组）的多普勒超声心动图资料与其血浆BNP水平进行对比分析。结果：与对照组相比, PAH组的左室舒张末内径（LVDd ）、右室舒张末内径（RVDd） 和肺动脉内径（PAd）明显增大(P<0.05),三尖瓣返流（VTR）速度增快及肺动脉收缩压（PASP）升高(P<0.05)。与对照组比较,PASP组患儿二尖瓣口多普勒血流频谱A峰流速（AV）、A峰流速积分（AVI）和E峰流速积分（EVI）及AV/EV和AVI/EVI比均逐渐明显增大(P<0.01);左室等容舒张时间明显延长(LIVRT)(P<0.05)。血浆BNP水平随着PASP增高而升高,与对照组相比差异有显著性（P<0.01）。PAH组先心病患儿其肺动脉压与二尖瓣口血流频谱AV/EV比值呈正相关（P<0.01）,二尖瓣口血流参数与血浆BNP水平亦呈正相关（P<0.01）。结论：CHD合并PAH患儿左室舒张功能与血浆BNP水平呈正相关;BNP在PAH引起左室舒张功能障碍的发生发展过程中发挥了重要作用。［中国当代儿科杂志,2010,12（1）：13-16］     

新生儿缺氧性肺动脉高压对左室舒张功能的影响及其与血浆脑利钠肽相关性研究

评估缺氧新生儿肺动脉高压（PAH）的发生及其对左室形态及功能的影响,探讨缺氧性PAH新生儿血浆脑利钠肽（BNP）水平与左室舒张功能的关系。方法　选择2003年11月至2008年11月解放军总医院和北京军区总医院附属八一儿童医院新生儿重症监护室（NICU）收治的缺氧新生儿52例,根据彩色多普勒超声检查是否存在PAH分为PAH组（34例）与对照组（18例）,比较2组患儿彩色多普勒超声心动图资料及其与左室舒张功能、血浆BNP水平的关系。结果　（1） 与对照组相比,PAH组左室舒张末内径（LVDd）、右室内径（RV）、肺动脉内径（PA）明显增大（P < 0.05）;三尖瓣反流峰值（VTR）流速增快及肺动脉收缩压（PASP）升高（P < 0.05）,室间隔增厚不明显（P > 0.05）。（2）PAH组二尖瓣口血流多普勒频谱A峰流速（AV）、舒张早期充盈时间速度积分（AVTI）及A峰流速与E峰流速比值（AV/EV）、左房充盈分数（AVTI /EVTI）均较对照组显著增加（P < 0.01）;PAH组的左室等容舒张时间（LIVRT） 延长,但与对照组相比差异无统计学意义（P > 0.05）,EV、舒张末期充盈时间速度积分（EVTI）及E峰减速时间（DT）较对照组亦无明显改变（P > 0.05）。（3） PAH组血浆BNP水平较对照组显著升高（P < 0.05）。（4）相关分析表明,PASP与AV/EV比值呈正相关（r = 0.4126, P < 0.01）;PAH组AV/EV比值与血浆BNP水平呈正相关 （r =0.4326,P < 0.01）。 结论　缺氧新生儿PAH已引起左室心肌重塑表现及左室舒张功能减低, 监测血浆BNP水平对新生儿缺氧性PAH伴左心功能受损的早期诊断具有十分重要的临床意义。     

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目的评估缺氧新生儿肺动脉高压(PAH)的发生及其对左室形态及功能的影响,探讨缺氧性PAH新生儿血浆脑利钠肽(BNP)水平与左室舒张功能的关系。方法选择2003年11月至2008年11月解放军总医院和北京军区总医院附属八一儿童医院新生儿重症监护室(NICU)收治的缺氧新生儿52例,根据彩色多普勒超声检查是否存在PAH分为PAH组(34例)与对照组(18例),比较2组患儿彩色多普勒超声心动图资料及其与左室舒张功能、血浆BNP水平的关系。结果(1)与对照组相比,PAH组左室舒张末内径(LVDd)、右室内径(RV)、肺动脉内径(PA)明显增大(P<0.05);三尖瓣反流峰值(VTR)流速增快及肺动脉收缩压(PASP)升高(P<0.05),室间隔增厚不明显(P>0.05)。(2)PAH组二尖瓣口血流多普勒频谱A峰流速(AV)、舒张早期充盈时间速度积分(AVTI)及A峰流速与E峰流速比值(AV/EV)、左房充盈分数(AVTI/EVTI)均较对照组显著增加(P<0.01);PAH组的左室等容舒张时间(LIVRT)延长,但与对照组相比差异无统计学意义(P>0.05),EV、舒张末期充盈时间速度积分(EVTI)及E峰减速时间(...     

先天性心脏病患儿血清儿茶酚胺 醛固酮测定临床意义研究

目的研究小儿左向右分流型先天性心脏病(CHD)血清儿茶酚胺(CA)[肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)]和醛固酮(ALD)的变化,分析其与心功能、容量负荷、肺动脉压力及心肌重塑的相关性。方法 2007年10月至2008年10月天津市儿童医院心脏科住院经彩色多普勒超声心动图检查确诊为左向右分流性CHD患儿53例,对照组20例,检测血清CA、ALD。采用实时三维超声心动图检测心脏房室腔径及心功能指标。结果 (1)CHD组血清NE、ALD高于对照组(P0.01)。(2)心衰组、大分流组、肺动脉高压组血清CA、ALD高于无心衰组、小分流组、无肺动脉高压组(P0.01)。(3)心衰组患儿左室舒张末期内径指数、左室舒张末期容积指数、左室质量指数均高于无心衰组(P0.01)。(4)血清CA与左房内径指数、左室舒张末期内径指数、左室舒张末期容积指数呈正相关(P0.01)。结论血清CA、ALD可作为早期诊断心力衰竭及肺动脉高压的血清学指标之一,CA与心肌重塑密切相关。     

米力农对先天性心脏病并肺动脉高压及心力衰竭患儿的术前干预作用

目的 探讨米力农对小儿先天性心脏病(CHD)并肺动脉高压(PAH)及心力衰竭(CHF)术前治疗的效果.方法 收集2006年1月-2008年7月上海交通大学附属儿童医院ICU收治的CHD患儿40例.年龄1个月～3岁.均为左向右分流型CHD,并PAH及CHF.将患儿随机分为研究组与对照组,各20例,二组病种、年龄、心功能及PAH程度比较无显著性差异.二组患儿均应用强心、利尿及扩血管治疗,另外,研究组20例加米力农静脉维持[0.5 μg/(kg·min)],对照组20例加多巴胺和多巴酚丁胺各5μg/(kg·min)静脉维持.分别于用药前、静脉维持用药72 h及停药后2 h通过彩色多普勒超声心动图检测二组各项心脏收缩、舒张功能及肺动脉压力指标.结果 研究组用药72 h各项心脏收缩功能指标(心脏指数、左室射血分数及左事短轴缩短率)和舒张功能指标(左室收缩时间间期、右室收缩时间间期及二尖瓣E峰和A峰比值)均显著优于对照组(Pa<0.05),肺动脉压力下降程度显著高于对照组(P<0.05);研究组改善心功能有效率显著高于对照组(P<0.05).结论 米力农对CHD并PAH及CHF患儿具有正性肌力和扩血管作用,能明显改善心功能和降低肺动脉压力,为手术纠正心脏畸形提供良好时机.     

儿童支气管哮喘肺动脉压力与右心舒张功能的变化

目的　探讨儿童支气管哮喘（哮喘） 患儿肺动脉压力与右心舒张功能的改变。方法　对２０ 例对照组,１４ 例轻、中型哮喘及１７ 例重型哮喘患儿以多普勒超声心动图测定指标：心率校正肺动脉血流加速时间（ＡＴｃ）;右室射血前期时间（ＲＰＥＰ） ;舒张早期快速充盈峰值流速（Ｅ）;舒张晚期快速充盈峰值流速（Ａ） ,估测肺动脉压及右心舒张功能,同时检测血气分析指标。结果　①儿童哮喘存在肺动脉高压,重型哮喘组（ＲＰＥＰ／ＡＴ１ ．２６ ±０．１９） 高于轻、中型组（１．１２ ±０．１５） 及对照组（０．８５±０．１４） Ｐ＜ ０ ．０１ 。②对照组（Ｅ／Ａ１．４１±０．２９） 与患儿右心舒张功能指标有明显差异Ｐ＜ ０．０１;重型哮喘患儿存在低氧血症（ＰａＯ２ ７ ．０２ ±０ ．８０ ｋＰａ） 。结论　哮喘患儿存在肺动脉高压和右心舒张功能下降,且随着病情进展,变化显著。     

肾上腺髓质素在先天性心脏病中的测定及临床意义

目的：肾上腺髓质素(ADM)对心血管疾病有多方面的影响,但其与先天性心脏病关系的研究较少。该实验通过检测不同类型先天性心脏病患儿体内ADM的变化,分析ADM在先天性心脏病病理生理中的作用。方法：筛选住院的48例先天性心脏病患儿,经超声心动图及心导管检查术证实,在心导管检查术中测定血流动力学指数及采血备测,依据血流动力学特征分为高肺血流非肺动脉高压组、高肺血流并肺动脉高压组、紫绀组,平均肺动脉压(mPAP)>20 mmHg为肺动脉高压的标准。选6例川崎病痊愈患儿作为对照组。采用特异性放射免疫法检测血浆ADM的水平。结果：先天性心脏病患儿股静脉中的血浆ADM水平较股动脉明显增高(P<0.05);与对照组相比,高肺血流并肺高压组及紫绀组中的ADM明显增高,均P<0.01;ADM与主动脉平均压(mSAP)、混合静脉血氧饱和度(MVsat)、主动脉血氧饱和度(AOsat)及肺血管阻力(Rp)之间有密切的关系。结论：高肺血流并肺动脉高压和紫绀型先天性心脏病患儿的ADM水平增高,ADM的变化同肺动脉阻力和缺氧有密切关系,推测ADM水平的升高可能有助于减轻肺动脉阻力和改善缺氧。     

多普勒超声估测肺动脉平均压、肺血流量及全肺阻力的研究

目的 探索应用多普勒超声技术估测肺动脉平均压（PAMP）、肺血流量（QP）及全肺阻力（TPR）的新方法。方法 对28例左向右分流的先天性心脏病患儿,应用多普勒超声技术,根据改良肺动脉/主动脉血流时间间期比法（FPA/FAO）和容积血流测量技术估测PAMP及QP,按Poiseuille公式计算TPR,并与心导管实测值对比。结果 多普勒超声技术估测的PAMP、QP、TPR与心导管实测值高度相关（r=0.83、0.70、0.72 P<0.01）。结论 多普勒超声技术可以准确地估测PAMP、QP、TPR。     

先天性左冠状动脉主干闭锁3例超声心动图特征及文献复习

目的 通过研究先天性左冠状动脉主干闭锁（LMCAA）的超声心动图表现,提高对LMCAA诊断的准确性。方法 回顾性分析经冠状动脉造影证实的3例LMCAA患儿的超声心动图检查结果,并复习相关文献,总结LMCAA超声心动图特征。结果 LMCAA特异性超声心动图特征：①主动脉左冠状动脉窦内无左冠状动脉主干开口,左冠状动脉主干近心端闭锁呈盲端,远心端内径细窄,发育不良;②右冠状动脉内径增宽;③多切面未显示左冠状动脉与肺动脉确切连接的证据。LMCAA非特异性超声心动图特征：①左心室明显扩大,左室收缩功能可正常或减低;②二尖瓣腱索、乳头肌回声显著增强,可伴有二尖瓣脱垂。彩色多普勒超声特征： ①收缩期二尖瓣口可见中至大量反流信号;② 左、右冠状动脉之间形成细小侧支循环; ③左冠状动脉前降支和回旋支血流为逆向灌注（向心性）;④发育不良的左冠状动脉虽然在肺动脉周围分布,但彩色多普勒超声不能显示其与肺动脉连接的确切逆灌血流信号。结论 LMCAA有特异性的超声心动图特征,提高对LMCAA的全面认识是诊断本病的关键。     

儿童先天性心脏病血清Apelin水平与肺动脉压关系的初步探讨

目的 初步探讨先天性心脏病患儿血清Apelin 水平与肺动脉压的关系.方法 手术治疗的先心病患儿126 例,检测患儿术前及术后第7 天的血清Apelin 水平.建立体外循环前检测并计算肺动脉收缩压/体循环收缩压(Pp/Ps)的比值,依据Pp/Ps 分组:无肺动脉高组压(PAH)组、轻度PAH 组、中度PAH 组和重度PAH 组;术后第7 天超声心动图估测肺动脉平均压(PAMP).结果 无PAH,以及轻、中、重度PAH 各组术前及术后的血清Apelin 水平依次降低,差异有统计学意义(PPr=-0.51,-0.54,P结论 先心病患儿并发肺动脉高压及其发展与血清Apelin 水平降低有关系,血清Apelin 对诊断先心病患儿是否并发肺动脉高压及其程度的意义值得深入研究.     

Tei指数和三尖瓣血流频谱评价左向右分流型先天性心脏病患儿右心功能的价值

目的探讨Tei指数和三尖瓣血流频谱评价左向右分流型先天性心脏病(CHD)患儿右心功能的价值。方法根据心室负荷将47例左向右分流型CHD患儿分为左心型组(30例)和右心型组(17例),应用三尖瓣血流频谱及Tei指数评价右心室功能,并与50例正常儿童进行对比研究。结果与正常组比较,CHD患儿42例三尖瓣血流频谱呈双峰型,均为舒张早期最大流速(EV)/舒张晚期最大流速(AV)>1;左心型组AV、A波流速积分(AVI)升高,右心型组EV、AV、E波流速积分(EVI)、AVI、E波减速时间(EDT)增大;左心型组右室等容舒张时间(IRT)和等容收缩时间(ICT) IRT延长;右心型组ICTI、RT和ICT IRT延长,右室射血时间(RVET)降低;两组CHD患儿右室Tei指数均增大;Tei指数与ICTI、RTI、CT IRT间呈显著性正相关(r=0.642,0.734,0.862 P均<0.01),与RVET间呈负相关(r=-0.481 P<0.01)。结论Tei指数能更简便、敏感、准确、综合评价右心室整体功能,与三尖瓣血流频谱结合可更全面了解CHD患儿右心功能。     

Assessment of left ventricular diastolic function by Doppler tissue imaging in children with end-stage renal disease

AIM: To evaluate left ventricular (LV) diastolic function in children with end-stage renal disease (ESRD) using conventional pulsed-Doppler echocardiography and Doppler tissue imaging (DTI), and to compare the findings with these two modalities. METHODS: Twenty-four children with ESRD and 22 healthy age- and sex-matched control subjects were assessed with conventional Doppler echocardiography and DTI. The scans of the renal disease patients were done after a dialysis session. Parameters related to LV systolic and diastolic function were compared in the ESRD and control groups. RESULTS: The ESRD patients had lower mean mitral E/A ratio both according to conventional Doppler echocardiography and TDI than the control subjects. The ESRD group also had significantly longer isovolumetric relaxation time (116+/-31 ms vs 97+/-3.1 ms, respectively; p<0.001), and significantly longer deceleration time (235+/-44 ms vs 202+/-35 ms, respectively; p<0.01) than the control group. CONCLUSION: DTI findings correlate well with conventional Doppler echocardiography findings. Children with ESRD show, after dialysis, echocardiographic signs of LV diastolic dysfunction.     

Myocardial performance index by tissue Doppler in bronchopulmonary dysplasia survivors

Bronchopulmonary dysplasia (BPD) survivors from the surfactant era were evaluated by echocardiography in a few studies and no significant differences were found between BPD and non-BPD children. In this study, we evaluated these children with myocardial performance index (MPI), which was obtained by tissue Doppler echocardiography (TDE) in addition to the conventional methods. Fifteen children with BPD who did not have any cardiopulmonary symptoms at the time of the study were examined. All children were studied with M-mode, two-dimensional and DE. Pulmonary artery systolic pressures (PAPs) were estimated from tricuspid regurgitant velocity, and MPI for both ventricles were obtained by TDE. Results were compared with those of term-born, age- and sex-matched control children. While the variables obtained by M-mode and DE did not differ between the groups, the right and left ventricular MPI were found to be significantly higher in the BPD group compared with the control group (mean right ventricular MPI 0.48 +/- 0.04 vs. 0.41 +/- 0.05; mean left ventricular MPI 0.47 +/- 0.05 vs. 0.39 +/- 0.06). In addition, mean PAPs values of the patients were found to be significantly higher than those of the controls (30.4 +/- 6.9 mmHg vs. 23.3 +/- 5.3 mmHg), and there was a positive correlation between PAPs and right ventricular MPI values in the BPD group (r = 0.5). While routine echocardiographic examinations revealed no difference between the groups, MPI measurements by TDE technique yielded significantly higher values in the BPD group. To this extent, our study is the first to show that survivors of BPD may, in fact, have a subclinical ventricular dysfunction.     

Body Mass Index Can Predict Left Ventricular Diastolic Filling in Asymptomatic Obese Children

To examine the effects of body mass index on left ventricular diastolic function, flow velocity patterns of the pulmonary vein and mitral valve were measured by pulse Doppler echocardiography in 21 asymptomatic obese children and were compared with those of an age-matched control population. The degree of obesity was calculated as (actual body mass index/ideal body mass index -1) x 100. The pulmonary venous flow indexes were peak systolic (S) and diastolic (D) velocities and peak D/S. The mitral inflow indexes were peak velocities of early diastole (E) and atrial contraction (A) and peak E/A. The pulmonary venous flow velocity pattern in obese patients was characterized by unchanged peak S, decreases in peak D (43 +/- 7 vs 51 +/- 8, p < 0.01) and peak D/S (0.98 +/- 0.19 vs 1.29 +/- 0.20, p < 0.01), suggesting the reduction in the early diastolic filling. The peak D/S decreased significantly with an increase in the percentage body mass index (r = -0.84, p < 0.01). In contrast to the pulmonary venous flow pattern (peak D > peak S) as seen in normal controls, all of the obese patients with > 70% over body mass index had abnormal pulmonary venous flow velocity patterns (peak D < peak S). The mitral flow velocity pattern in obese patients was also characterized by a decrease in early diastolic filling. However, these indices did not correlate with an increase in the percentage over body mass index. This study suggests that body mass index predicts the abnormality of left ventricular diastolic filling assessed by pulmonary venous flow patterns.     

Cardiac mass and function, carotid artery intima media thickness, homocysteine and lipoprotein levels in children and adolescents with growth hormone deficiency

INTRODUCTION: Early atheromatic changes have been found in the carotid and the femoral arteries of young adults with growth hormone (GH) deficiency (GHD). It has been shown that adults with GHD have increased cardiovascular risk factors. The aim of this study was to compare atherosclerotic risk factors in children with GHD and a normal population. PATIENTS AND METHODS: Twenty-five patients (10 girls, 15 boys) with GHD qualified for GH replacement treatment were included in the study. The control group consisted of 22 healthy children (11 girls, 11 boys) with no family history of atherosclerosis and cardiovascular disease. Cardiac mass and function was evaluated by one-dimensional, two-dimensional echocardiography and the Doppler method. Common carotid intima-media thickness was measured with a linear probe (7.5 MHz). Lipid metabolism parameters (total cholesterol, HDL- and LDL-cholesterol, triglycerides), lipoprotein A (Lp(a)) and homocysteine levels were measured. RESULTS: Cardiac dimensions and systolic parameters were within normal values in both groups. The mean index of left ventricular mass (68.37 +/- 18.64 g/m2) in patients with GHD did not differ significantly compared to controls (68.48 +/- 15.56 g/m2). No significant differences between the study and control group were observed when comparing systolic and ejection fraction values. Significantly higher mean values of IVRT parameter were found (70.8 +/- 14.2 ms vs 64.09 +/- 8.54% ms; p < 0.05). Other parameters characterizing systolic function were not significantly different. The mean concentration of total (178.28 +/- 31.1 mg/dl) and LDL-cholesterol (106 +/- 28.68 mg/dl) was significantly higher in patients with GHD than in controls (157.59 +/- 22.39 mg/dl, 84.54 +/- 22.01 mg/dl; p <0.05). Lp(a) (40.34 +/- 12.45 mg/dl vs 11.02 +/- 4.82 mg/dl; p <0.05) and apolipoprotein B (ApoB) (71.12 +/- 18 mg/dl vs 56.72 +/- 11.46 mg/dl; p < 0.05) were significantly higher in patients with GHD. Carotid artery intima-media thickness (IMT) values were significantly higher in patients with GHD compared to healthy children (IMT-L 0.53 +/- 0.058 mm vs 0.41 +/- 0.045 mm; IMT-R 0.54 +/- 0.048 vs 0.42 +/- 0.42 mm, respectively). CONCLUSIONS: No significant differences in parameters of cardiac systolic function and left ventricular mass were found between patients with GHD and healthy children. However, significantly higher Isovolumetric relaxation time (IVRT) values in the group of patients may suggest impaired diastolic function. Significantly elevated IMT values in the common carotid artery were observed in patients with GHD in comparison with healthy children, which may prove the onset of atheromatosis.     

Mitochondrial myopathy,encephalopathy, lactic acidosis,and stroke-like episodes (MELAS) decrease in diastolic left ventricular function assessed by echocardiography

Summary Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) are known to be associated with cardiomyopathy. Systolic and diastolic left ventricular functions were assessed by M-mode and Doppler echocardiography in four patients with MELAS and in 14 normal controls. The interventricular septal thickness and left ventricular posterior wall thickness were greater (11.0±1.6 mm vs. 5.8±0.7 mm and 11.0±2.2 mm vs. 5.9±0.8 mm) in patients with MELAS than in a control group. Parameters of systolic left ventricular functions (ejection fraction, shortening fraction, systolic time intervals, and mean Vcf) and left ventricular dimensions were not significantly different between the two groups. To assess the diastolic function, blood flow velocity across the mitral valve was measured by Doppler echocardiography and various indexes were obtained. In patients with MELAS, the impairment of diastolic left ventricular filling was demonstrated by decrease in the following indexes: peak flow velocity in the early passive filling period (E) (0.76±0.10 m/s vs. 0.94±0.09 m/s), integrated velocity for total E (10.2±1.3 vs. 13.0±0.9), the ratio of E and late atrial filling integrated velocities (1.72±0.06 vs. 2.49±0.29).     

Persistent pulmonary hypertension in premature neonates with severe respiratory distress syndrome.

Cardiac catheterization studies have demonstrated that Doppler-derived flow velocities in the ductal flow jet and the left pulmonary artery accurately predict the aortopulmonary pressure difference and left-to-right shunt size in newborns. To assess the presence of persistent pulmonary hypertension in premature newborns with various degrees of respiratory distress syndrome (RDS) severity, we estimated pulmonary artery pressure from the aortopulmonary pressure difference and pulmonary blood flow from the left pulmonary artery flow velocity with color-flow-directed, pulsed Doppler echocardiography. Seventy-nine premature neonates were divided into three groups--no or mild RDS (n = 27), severe RDS (n = 38), and fatal RDS (n = 14)--and compared with a group of healthy term neonates (n = 34). In premature and term neonates with no/mild RDS the mean +/- SEM aortopulmonary pressure difference increased from 7.3 +/- 0.4 and 6.6 +/- 0.5 mm Hg to 22.8 +/- 1.4 and 21.4 +/- 1.1 mm Hg over the first 24 hours (P < .001). The mean aortopulmonary pressure difference was 0.9 +/- 0.3 mm Hg during the first 72 hours in neonates with fatal RDS, but increased from 1.5 +/- 0.3 mm Hg at 4 hours to 7.4 +/- 0.6 at 24 hours and 21.5 +/- 0.7 mm Hg at 72 hours of age in neonates with severe RDS. Left pulmonary artery velocity time integrals were 18.3 +/- 0.5 cm in premature and 18.8 +/- 0.5 cm in term neonates with no/mild RDS at 12 hours vs 11.2 +/- 0.4 cm in neonates with severe and 9.9 +/- 0.5 cm in neonates with fatal RDS (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)