危重右心和左心阻塞性病变围产期循环转换的比较

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2024-11-01 DOI:10.1016/j.echo.2024.07.007

Proscovia M. Mugaba MD , Lisa K. Hornberger MD , Angela McBrien MBBCh, MD , Lindsay Mills MD , Luke G. Eckersley MBBS, PhD

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引用次数: 0

摘要

背景：在左心发育不全综合征（HLHS）的围产期转变过程中，可观察到全身血流（Qs）和脑血流减少，肺血流（Qp）增加，从而导致血流动力学不稳定。在本研究中，我们探讨了与 HLHS 和健康对照组相比，临界肺流出道梗阻（POFO）的围产期变化是否相似或不一致：方法：在妊娠36-39周时进行前瞻性超声心动图检查，然后在进行心脏干预前于出生后6-96小时内进行连续超声心动图检查。比较三组间的合并心输出量（CCO）、上腔静脉（SVC）、Qs和Qp流速以及大脑中动脉（MCA）、腹腔动脉和肠系膜上动脉的阻力指数（RI）：结果：在胎儿POFO（n=19）和HLHS（n=31）中，由于搏出量增加，CCO与对照组（n=21）相当，但与HLHS相比，POFO的CCO较低（p）：POFO 和 HLHS 在新生儿早期表现出不同的急性血流动力学变化，POFO 早期 CCO 下降，HLHS 早期 CCO 上升。两者都表现出 Qs 和 SVC（脑血流）的早期受损以及脾血流的持续改变。

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A Comparison of Perinatal Circulatory Transition in Critical Right and Left Heart Obstructive Lesions

Background

During perinatal transition in hypoplastic left heart syndrome (HLHS), reduced systemic blood flow (Qs) and cerebral blood flow and increased pulmonary blood flow (Qp) are observed, contributing to hemodynamic instability. The aim of the present study was to explore whether similar or discordant perinatal changes occur in critical pulmonary outflow tract obstruction (POFO) compared with HLHS and healthy control subjects.

Methods

Echocardiography was prospectively performed at 36 to 39 gestational weeks and then serially from 6 to 96 hours after birth, before cardiac intervention. Combined cardiac output (CCO), superior vena cava (SVC) flow rate, Qs and Qp, and resistance indices (RIs) in the middle cerebral artery (MCA), celiac artery, and superior mesenteric artery were compared among the three groups.

Results

In fetal POFO (n = 19) and HLHS (n = 31), CCO was comparable with that in control subjects (n = 21) because of elevated stroke volume, but CCO in POFO was lower compared with HLHS (P < .01). Compared with control subjects, POFO CCO was lower at 6 hours after delivery but comparable at 24 to 96 hours. In contrast, from 6 to 96 hours, the HLHS group had higher CCO than POFO and control subjects. Compared with control subjects, both neonates with POFO and those with HLHS had lower Qs and SVC flow (POFO at 24 hours, P < .001; HLHS 6-hour Qs and 6- to 24-hour SVC flow). Compared with control subjects, Qp was increased in POFO at 48 to 96 hours (P < .05) and in HLHS at all time points (P < .001). Compared with fetal MCA RI, postnatal MCA RI was acutely higher in both POFO and HLHS, whereas in control subjects, it tended to decrease postnatally. Celiac artery RI and superior mesenteric artery pulsatility index were higher in POFO and HLHS from 6 to 48 hours vs control subjects.

Conclusions

POFO and HLHS demonstrate divergent acute hemodynamic changes in the early neonatal period, with early decreased CCO in POFO and increased CCO in HLHS. Both demonstrate early compromise in Qs and SVC (cerebral flow) and ongoing altered splanchnic flow.

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.