Quantitative assessment of left ventricular regression in two-staged arterial switch

MENG Hong; LI Hui; WANG Jianpeng; LI Shoujun; YAN Jun; WANG Qiang; WANG Hao

doi:10.16245/j.cnki.issn1008-6978.2021.04.002

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Quantitative assessment of left ventricular regression in two-staged arterial switch

更新时间：2021-10-08

- Quantitative assessment of left ventricular regression in two-staged arterial switch
- Journal of Clinical Ultrasound in Medicine Vol. 23, Issue 4, Pages: 246-250(2021)
- 作者机构：
  
  1. 中国医学科学院阜外医院超声影像中心
  2. 中国医学科学院阜外医院心外科
- 作者简介：
- 基金信息：
- DOI：10.16245/j.cnki.issn1008-6978.2021.04.002
  CLC： R726.5
- Published：2021，
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[1]孟红,李慧,王剑鹏,李守军,闫军,王强,王浩.分期大动脉调转手术的左室退化定量评估[J].临床超声医学杂志,2021,23(04):246-250.

MENG Hong, LI Hui, WANG Jianpeng, et al. Quantitative assessment of left ventricular regression in two-staged arterial switch. [J]. Journal of Clinical Ultrasound in Medicine 23(4):246-250(2021)
[1]孟红,李慧,王剑鹏,李守军,闫军,王强,王浩.分期大动脉调转手术的左室退化定量评估[J].临床超声医学杂志,2021,23(04):246-250. DOI： 10.16245/j.cnki.issn1008-6978.2021.04.002.

MENG Hong, LI Hui, WANG Jianpeng, et al. Quantitative assessment of left ventricular regression in two-staged arterial switch. [J]. Journal of Clinical Ultrasound in Medicine 23(4):246-250(2021) DOI： 10.16245/j.cnki.issn1008-6978.2021.04.002.

摘要

目的探讨左室退化的定量标准

分析影响左室训练效果的因素

评估动脉调转手术（ASO）效果。方法收集在我院就诊的室间隔完整型完全性大动脉转位患儿86例

43例接受左室训练术和分期ASO（A组）

43例接受一期ASO（B组）。测量并计算两组患儿左室前后径及其Z值、左室质量指数（LV mass指数）、左室压力退化率、LV mass指数退化率、左室与右室压力比值（LV/RV）。比较两组上述参数的差异

随访患儿接受ASO情况

Logistic回归分析影响左室训练效果的因素

分析各超声心动图参数与LV/RV的相关性

绘制受试者工作特征曲线分析判断ASO时机的指标及其效能。结果 A组患儿中室间隔呈"D"型8例

室间隔呈"香蕉"型35例

B组患儿室间隔形态均正常

两组室间隔形态、就诊年龄、LV mass指数、左室前后径Z值、LV/RV比较

差异均有统计学意义（均P<0.05）。A组43例患儿中

10例在训练10 d内完成ASO

其余31例在训练后平均281.6 d完成ASO

余2例接受2次肺动脉环缩术。Logistic回归分析发现患儿就诊年龄是影响左室训练成功的独立因素。相关性分析表明左室前后径Z值、LV mass指数与LV/RV均呈正相关（r=0.602、0.676

均P=0.0001）。判断分期ASO时机的最佳超声指标为LV mass指数

其次为左室前后径Z值

诊断临界值分别为59.7 g/m2和-1.45

曲线下面积分别为0.97、0.93

敏感性分别为88.9%、88.9%

特异性分别为97.4%、82.1%。结论 LV mass指数和左室前后径Z值可以反映LV/RV

判断ASO手术时机;患儿就诊年龄是影响左室训练成功的独立因素。左室训练安全有效

可为已出现左室退化的室间隔完整型完全性大动脉转位患儿提供治疗机会。

Abstract

Objective To explore the quantitative standard of left ventricular（LV）regression

analyze the factors that affect the effect of LV retraining

and to evaluate the effect of arterial switch surgeration（ASO）.MethodsEighty-six children with intact ventricular septal/transposition of great artery（TGA/IVS）were collected.43 received LV retraining and the second staged ASO（group A）

and 43 received one-staged ASO（group B）. The LV anterior-posterior diameter（LVEDd）and Z value

LV mass index

LV pressure regression rate

LV mass index degradation rate

and LV to right ventricular pressure ratio（LV/RV）were measured and calculated.The difference of the above parameters between the two groups were compared

the condition of children receiving ASO were followed up

Logistic regression analysis of factors affecting the effect of left ventricular training was analyzed

the correlation between each echocardiographic parameter and LV/RV was analyzed

and receiver operating characteristic curve was drawn determine the indicators of ASO timing and its effectiveness.Results ventricular septum showed"D"type

35 cases of ventricular septum showed"banana"type

and ventricular septal morphology of children in group B were normal.The ventricular septal morphology

ages

LV mass index

the Z value of LVEDd and LV/RV were statistically differenct between the two groups（all P<0.05）.Among the 43 children in group A

10 patients completed ASO within10 d of training

31 patients completed ASO on average 281.6 d after training

and 2 patients completed ASO after receiving pulmonary artery bandings twice.Logistic regression analysis showed that the age of the child’s visit was an independent factor affecting the success of LV retraining.Correlation analysis showed that the Z value of LVEDd

LV mass index were positively correlated with LV/RV（r=0.602

0.676

both P=0.0001）.The best ultrasound index for judging the timing of staging ASO was the LV mass index

followed by the Z value of LVEDd.The diagnostic cut-off values were 59.7 g/m2 and-1.45

respectively.The area under the curve were 0.97 and 0.93

and the sensitivity were 88.9% and 88.9%

the specificity were 97.4% and 82.1%

respectively.Conclusion ASO operation

the age of the child’s visit is an independent factor that affects the success of LV retraining.LV retraining is safe and effective

and can provide the treatment opportunities for the TGA/IVS children with LV regression.

关键词

超声心动描记术完全性大动脉转位左室退化左室训练术动脉调转手术

Keywords

EchocardiographyTransposition of great arteryLeft ventricular regressionLeft ventricular retrainingArterial switch operation

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