森宁手术后及时发现大动脉 D 型横位儿童亚临床心力衰竭：单中心经验

Pediatric Sciences Journal Pub Date : 2024-01-01 DOI:10.21608/cupsj.2024.254621.1111

A. AbdelMassih, Fatma Al Zahraa Mostafa, Reem Ismail, Mohamed Abd El Raouf, Mohammed Mohammed Abd El Raouf, Ayman Badr, Noha Ali

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引用次数: 0

摘要

:背景：阿克-森宁（Ake Senning）于1958年提出了心房转换手术，用于治疗大动脉D型横位（D-TGA）患者。心房转换手术的主要缺点是每10年有7%至10%的患者会出现右心室（RV）功能衰竭。工作目标使用常规和非常规超声心动图检测心房转换修复术后 D-TGA 儿童的亚临床 RV 功能衰竭。研究对象和方法：我们研究了在开罗大学儿科专科医院术后心脏病学门诊接受心房转换手术的 25 名 D-TGA 患儿。他们没有心衰症状。他们接受了常规超声心动图、组织多普勒和斑点追踪成像（包括 RV 整体纵向应变（RV GLS））检查，以根据纽约心脏病协会（NYHA）的分类检测亚临床心衰。结果与匹配对照组进行了比较。结果研究组的平均年龄（标准差）为 6.8 ± 4.3 岁，手术时的平均年龄为 14.2 ± 12.7 个月（P=0.001）。与对照组的 RV GLS（-20.2 ± 1.4%）相比，病例的平均 RV 整体纵向应变（GLS）（-14.5± 1.5%）明显受损（P <0.001）。病例的三尖瓣环平面收缩期偏移（TAPSE）（12.7±3.1 mm）低于对照组的TAPSE（15.5±2.3 mm）（P= 0.001）。病例的 RV 心肌性能指数（MPI）（0.47 ± 0.10）高于对照组的 RV MPI（0.34 ± 0.03）（P＜0.001）。手术时的年龄与 RV GLS 呈负相关（r = -0.435）（p = 0.030）。非常规超声心动图参数 RV MPI 和 RV GLS 可在所有研究病例中检测到房室转换后的亚临床心衰。结论非常规超声心动图参数 RV MPI 和 RV GLS 对检测森宁换房术后 D-TGA 患者的 RV 功能障碍和及时诊断亚临床心力衰竭具有更高的灵敏度，而常规超声心动图检查则无法检测到这些功能障碍。证据等级

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Timely Detection of Subclinical Heart Failure Among Children with D-Transposition of Great Arteries after Senning Operation: A Single Center Experience

: Background : Atrial switch operation, was introduced by Ake Senning in 1958 for patients with D-transposition of great arteries (D-TGA). The major disadvantage of the atrial switch procedure is right ventricle (RV) failure in up to 7% to 10% of patients per 10 years. Aims of the work: To detect subclinical RV failure in children with D-TGA after atrial switch repair using conventional and nonconventional echocardiography. Subjects and Methods: We studied 25 children with D-TGA who underwent atrial switch operation following in the Postoperative Cardiology Clinic at Cairo University Specialized Pediatric Hospital. They did not have symptoms of heart failure. They underwent conventional echocardiography, tissue Doppler and speckle tracking imaging including RV global longitudinal strain (RV GLS) to detect subclinical heart failure according to New York Heart Association (NYHA) classification. The results were compared to a matched control group. Results: Mean age ± standard deviation of the studied group was 6.8 ± 4.3 years while mean age at time of operation ranged 14.2 ± 12.7 months (p=0.001). Mean RV global longitudinal strain (GLS) of cases (-14.5± 1.5%) was significantly impaired compared to RV GLS of controls (-20.2 ± 1.4%) (p <0.001). Tricuspid annular plane systolic excursion (TAPSE) of cases (12.7 ± 3.1 mm) was lower than TAPSE of controls (15.5 ± 2.3 mm) (p= 0.001). While RV myocardial performance index (MPI) of cases (0.47 ± 0.10) was higher than RV MPI of controls (0.34 ± 0.03) (p <0.001). There was a negative correlation between age at the time of surgery and RV GLS (r = -0.435) (p = 0.030). Non-conventional echocardiographic parameters RV MPI and RV GLS detected subclinical heart failure among all studied cases post-atrial switch. Conclusions: Non-conventional echocardiographic parameters RV MPI and RV GLS had higher sensitivity for detection of RV dysfunction and timely diagnosis of subclinical heart failure in patients of D-TGA after Senning atrial switch operation that was not detected by conventional echocardiography. Level of Evidence of

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Pediatric Sciences Journal

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