多普勒超声测量非限制性缺损先心病肺血管阻力的可靠性分析

目的 探讨超声心动图测量非限制性先心病患者肺血管阻力的可靠性.方法 选择先天性非限制性三尖瓣后型缺损患者19例(室间隔缺损患者13例,非限制性动脉导管未闭患者6例),对照组患者19例作为研究对象.用连续多普勒测量三尖瓣最大返流速度,右室流出道前向血流频谱并测量流速时间积分TVIRVOT.按照公式1 PVRecho=TRV/TVIRVOT+0.16和公式2 PVRecho2=TRV2/TVIRVOT*5.19-0.4计算PVR.全部患者超声检查完毕后3日内完成右心导管检查.对两种测量结果行相关性分析.结果 非限制性室间隔缺损多数呈现双向分流,公式2测量的结果与右心导管检查结果高度相关,对于右室流出道增大患者,这种相关性减弱.超声与右心导管测量肺血管阻力在非限制性动脉导管未闭患者中无显著相关.结论 超声心动图多普勒能够较可靠测量非限制性室间隔缺损先心病,尤其是双向分流可疑艾森曼格综合征患者肺血管阻力,并可能成为有用且性价比高的无创评价和跟踪肺血管阻力变化的工具.

Reliability of Doppler-based Measurement of Pulmonary Vascular Resistance in Congenital Heart Disease with Non-restrictive Defect

Objective To explore the reliability of echocardiography in measuring the pulmonary vascular resistance (PVR) in congenital heart disease with non-restrictive defect.Methods 19 patients with congenital non-restrictive tricuspid valve defect (13 non-restrictive ventricular septal defect (VSD) and 6 non-restrictive patent ductus arteriosus) were enrolled in the study,and the other 19 patients with small defect were selected in the control group.The Doppler echocardiography was used to measure the peak velocity of tricuspid regurgitation and the forward blood flow spectrum and time-velocity integral of the right ventricular outflow tract (TVIRVOT).PVR was calculated according to the first formula PVRecho=TRV/TVIRVOT+0.16 and the second formula PVRecho2=TRV2/TVIRVOT*5.19-0.4.Meanwhile,the right cardiac catheterization (RHC) was performed within three days after the echocardiography examination of all the patients.The correlation was analyzed between the results obtained.Results Two direction shunt appeared in most of the non-restrictive VSD.The PVR calculated by the second formula was positively correlated with that by RHC.The correlation abate for the patients with enlarged RVOT.In patent ductus arteriosus with non-restrictive shunt,there is no significant correlation between the PVR measured by echocardiography and that by catheterization.Conclusion The Doppler echocardiography is reliable in measuring the congenital heart disease with non-restrictive VSD and especially helpful in measuring PVR of suspected Eisenmenger syndrome with bidirectional shunt.Therefore,it may become a useful and cost-effective tool to evaluate PVR without invasion and keep track of PVR changes.