上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (6): 643-.doi: 10.3969/j.issn.1674-8115.2018.06.010

• 论著·临床研究 • 上一篇    下一篇

不同类型先天性心脏病合并二尖瓣反流的超声评估

王静1，孙锟2，李奋1，吴兰平1   

  1. 1. 上海交通大学医学院附属上海儿童医学中心心内科，上海200127；2. 上海交通大学医学院附属新华医院小儿心内科，上海200092
  • 出版日期:2018-06-28 发布日期:2018-07-03
  • 通讯作者: 吴兰平，电子信箱：wulanping@scmc.com.cn。
  • 作者简介:王静（1983—），女，住院医师，硕士；电子信箱：tie119@126.com。
  • 基金资助:
    国家自然科学基金（81470443）

Ultrasonic evaluation of different congenital heart diseases with mitral regurgitation

WANG Jing1, SUN Kun2, LI Fen1, WU Lan-ping1   

  1. 1. Department of Pediatric Cardiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 2. Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2018-06-28 Published:2018-07-03
  • Supported by:
    National Natural Science Foundation of China, 81470443

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摘要： 目的·应用二维超声心动图评估不同类型先天性心脏病（congenital heart disease，CHD）合并二尖瓣反流（mitral regurgitation，MR）患儿特征表现。方法·收集217例单纯CHD合并MR患儿（MR组）及85例正常儿童（对照组），将MR组再分为3组，分别为室间隔缺损（ventricular septal defect，VSD）合并MR组、动脉导管未闭（patent ductus arteriosus，PDA）合并MR组和主动脉缩窄（coarctation，CoA）合并MR组，观察患儿CHD类型特点（缺损位置和大小、降主动脉压差）及二尖瓣形态特点，并比较MR组与对照组房室腔大小、二尖瓣瓣环大小等指标差异。结果·与对照组相比，MR组均存在房室腔增大、瓣环扩张、二尖瓣/三尖瓣瓣环比值升高，而左室收缩功能，除CoA合并MR组降低外，其余2组未降低。合并CHD特点：VSD缺损附着组织较少且分流较大，PDA分流直径多数大于0.3 cm，CoA压差均大于48 mmHg（1 mmHg0.133 kPa）。此外，3组MR患儿均存在不同程度的二尖瓣器质性病变。结论·以3种CHD为基础的MR，可能与房室腔增大、二尖瓣瓣环扩张、二尖瓣/三尖瓣瓣环比升高及不同程度的二尖瓣器质性病变相关。这些异常表现可为临床MR患儿手术方案设计提供指导。

关键词: 先天性心脏病, 二尖瓣反流, 二维超声心动图, 手术

Abstract:

Objective · To evaluate the characteristics of different congenital heart diseases (CHD) with mitral regurgitation (MR)two-dimensional echocardiography. Methods · A total of 217 patients with simple CHD and MR and 85 normal children (control group) were enrolled for analysis. All the patients with MR were divided into 3 groups, i.e. ventricular septal defect (VSD) with MR, patent ductus arteriosus (PDA) with MR and coarctation (CoA) with MR. The size of defects, the peak pressure gradient of CoA and the malformation of mitral valve were described respectively in MR groupsechocardiography. In addition, the bore of left atrioventricular cavity, the left ventricular ejection fraction (LVEF) and the diameter of mitral valve annulus were compared with control group. Results · Compared with control group, left atrium diameter, left ventricular diameter, mitral annular diameter (MAD), and MAD/tricuspid annulus diameter (MAD/TAD) increased in 3 MR groups, while only LVEF decreased significantly in CoA with MR group. The characteristics of CHD with MR were displayed as below. VSD was with less tissue formation and large defect diameter, the diameters of PDA were over 0.3 cm mostly and the peak pressure gradients of CoA were all above 48 mmHg (1 mmHg0.133 kPa). Furthermore, there were different mitral valve morphology in the 3 MR groups. Conclusion · The mechanism of MR based on CHD may be related to increased atrioventricular cavity, MAD, MAD/TAD and abnormal morphology of mitral valve. These abnormal manifestations observedtwo-dimensional echocardiography are useful for surgery inthe patients with MR.

Key words: congenital heart disease, mitral regurgitation, two-dimensional echocardiography, surgery

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