超声组织多普勒成像评价儿童先天性心脏病并肺动脉高压患者心室功能研究

目的 探讨超声组织多普勒成像技术评价儿童先天性心脏病并肺动脉高压患者心室功能的价值.方法 20例先天性心脏病并肺动脉高压、20例先天性心脏病无肺动脉高压患儿及24例门诊体检健康儿童,分别行组织多普勒超声心动图检查.心尖四腔心切面测量左心室侧壁二尖瓣环附着处、右心室侧壁三尖瓣环附着处收缩期S波峰速度(Sm)、舒张早期负向E波峰速度(Em)、舒张晚期负向A波峰速度(Am)、等容收缩间期(ICT)、等容舒张间期(IRT)、射血时间(ET),计算左心室、右心室Tei指数,比较各组间差异,并分析先天性心脏病并肺动脉高压组患儿右心室组织多普勒参数与肺动脉收缩压(sPAP)的相关性.结果 先天性心脏病并肺动脉高压组患儿左心室、右心室Em及左心室ET降低,而左心室、右心室Am、ICT、IRT、Tei指数均异常升高.右心室IRT与sPAP具有良好的正相关.结论 儿童先天性心脏病并肺动脉高压患者左右心室功能均受损,以右心室舒张功能及左心室舒张收缩功能下降为主,右心室IRT可作为预测肺动脉高压的新无创指标.

Tissue Doppler imaging for assessment of ventricular function in children with pulmonary arterial hypertension secondary to congenital heart diseases

Objective To investigate the value of tissue Doppler imaging（TDI） in assessing the ventricular function in children with pulmonary arterial hypertension secondary to congenital heart diseases. Methods From Aug 2010 to Oct 2011 ,twenty children with pulmonary arterial hypertension secondary to congenital heart diseases, twenty children with congenital heart diseases not combined with pulmonary arterial hypertension and twenty-four healthy children underwent tissue Doppler echocardiographic evaluation of both left and right ventricular function. The peak systolic velocity （ Sm ）, peak early diastolic velocity （ Em ）, peak late diastolic velocity （ Am ）, isovolumic contraction time （ ICT）, isovolumic relaxation time （IRT） and ejection time （ET） of the anterior tricuspid annulus and posterior mitral annulus were acquired from apical four-chamber view respectively. Tel index of left ventricle（LV） and right ventricle（RV） were measured. Results Compared with control groups, LV, RV Em and LV ET were lower, while LV, RV Am, ICT, IRT and Tei index were higher in children with pulmonary arterial hypertension secondary to congenital heart diseases. There was a significant positive correlation between RV IRT and systolic pulmonary arterial pressure（sPAP）. Conclusions Both systolic and diastolic function of left ventricle and mainly diastolic function of right ventricle were impaired in children with pulmonary arterial hypertension secondary to congenital heart diseases. RV IRT can be used as an alternative non-invasive method to assess sPAP.