修复后死亡的先天性膈疝患者的心室功能障碍

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-10-12 DOI:10.1016/j.jpedsurg.2024.162002

Catherine M. Avitabile , Yan Wang , Devon Ash , Sabrina J. Flohr , Leny Mathew , Natalie Rintoul , Holly L. Hedrick

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引用次数: 0

摘要

背景：超声心动图（echo）对心室功能的定量测量可预测小儿肺动脉高压（PH）的死亡率，但对先天性膈疝（CDH）相关PH的研究却很有限。很少有研究报告 CDH 非存活者出生一周后的定量回声数据：一项单中心回顾性横断面队列研究纳入了 2013 年 1 月至 2022 年 4 月间出生的 CDH 患者，这些患者在手术修复后存活，但在新生儿住院期间死亡。对右室（RV）和左室（LV）的大小和功能进行了定量测量，包括三尖瓣环平面收缩期偏移Z-score（TAPSEZ）、RV分数面积变化（FAC）、RV/LV比值、LV偏心指数、LV M型尺寸和RV/LV收缩应变。使用Wilcoxon秩和检验比较修复后≤30天（"早期"）与修复后＞30天（"晚期"）死亡患者的数据：25例（11例早期，14例晚期）死亡患者的回声图像可供分析。按舒张末期尺寸Z-score计算，修复后早期与晚期死亡患者的左心室尺寸较小[-3.03 (-3.93, -2.51) vs. -0.24 (-2.11, 0.53)，p = 0.021]。修复后早死与晚死的患者的 RV 功能（TAPSEZ、RVFAC、RV 整体和游离壁应变）和 LV 功能（心尖 4 腔应变）呈恶化趋势：这些初步研究结果支持今后研究心室发育不良和功能障碍对死亡率的影响，以及根据CDH患者的定量回声结果进行风险分层的机会：队列研究，4。

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Ventricular Dysfunction in Patients With Congenital Diaphragmatic Hernia Who Die After Repair

Background

Quantitative echocardiographic (echo) measures of ventricular function predict mortality in pediatric pulmonary hypertension (PH), but studies in congenital diaphragmatic hernia (CDH)-related PH are limited. Few studies report quantitative echo data beyond the first week of life in CDH non-survivors.

Methods

A single-center retrospective, cross-sectional, cohort study included CDH patients born between January 2013 and April 2022 who survived to surgical repair but died during the neonatal hospitalization. Quantitative measures of right (RV) and left ventricular (LV) size and function including tricuspid annular plane systolic excursion Z-score (TAPSEZ), RV fractional area change (FAC), RV/LV ratio, LV eccentricity index, LV M-mode dimensions, and RV/LV systolic strain were performed offline on the last echocardiogram before death. Data were compared between patients who died ≤30 days after repair (“early”) vs. >30 days after repair (“late”) using the Wilcoxon rank sum test.

Results

Twenty-five (11 early, 14 late) deceased patients had echo images available for analysis. LV size by end-diastolic dimension Z-score was smaller in patients who died early vs. late after repair [-3.03 (−3.93, −2.51) vs. −0.24 (−2.11, 0.53), p = 0.021]. There were trends toward worse RV function (TAPSEZ, RVFAC, RV global and free wall strain) and LV function (apical 4 chamber strain) in patients who died early vs. late after repair.

Conclusion

These preliminary findings support future study of the impact of ventricular hypoplasia and dysfunction on mortality and opportunities for risk stratification based on quantitative echo findings in CDH.

Level of Evidence

Cohort study, 4.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.