临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (1): 49-.doi: 10.3969/j.issn.1000-3606.2020.01.012

• 综合报道 • 上一篇    下一篇

儿童先天性心脏病合并心肌致密化不全的介入治疗及随访分析

王野峰 1, 胡原 2, 杨舟 1, 肖云彬 1, 左超 1, 陈智 1   

  1. 湖南省儿童医院1.心血管内科,2.超声科(湖南长沙 410007)
  • 出版日期:2020-01-15 发布日期:2020-02-03
  • 通讯作者: 陈智 电子信箱:eyxxgchenzhi@163.com
  • 基金资助:
    湖南省卫生计生委科研课题计划项目(No.20180549)

Interventional therapy and follow-up analysis of congenital heart disease complicated with left ventricular non-compaction in children

WANG Yefeng1, HU Yuan2, YANG Zhou1, XIAO Yunbin1, ZUO Chao1, CHEN Zhi1   

  1. 1.Department of Cardiology, 2.Department of Ultrasound, Hunan Children’s Hospital, Changsha 410007, Hunan, China
  • Online:2020-01-15 Published:2020-02-03

摘要: 目的 探讨儿童先天性心脏病合并心肌致密化不全介入治疗的安全性及预后。方法 回顾分析2016年1月 至2017年10月收治的先天性心脏病合并心肌致密化不全患儿的临床资料。比较患儿在心脏介入治疗前后,以彩色多普勒 超声心动图测量的非致密心肌/致密心肌(N/C)比值及心功能参数的变化;记录并发症发生情况。结果 共纳入患儿25例, 男9例、女16例,中位年龄为1岁(0.14~8岁);动脉导管未闭22例、房间隔缺损2例、室间隔缺损1例。术前、术后1、 6、12 个月之间左心室舒张末期内径(LVEDD)-Z值和N/C比值的差异均有统计学意义(P<0.05),均以术后12月时为最低;其 中6例患儿在随访过程中心肌致密化不全基本消失。但各时间点之间左室射血分数(LVEF)的差异无统计学意义(P>0.05)。 术前及术后1、 6、12个月,患儿N/C比值、LVEDD-Z值与LVEF值均无相关性(P>0.05)。 术后随访中位时间19个月(12 ~27个月),随访过程中未出现心血管不良事件及心律失常发生。结论 儿童先天性心脏病合并心肌致密化不全如满足介 入治疗指征,应积极介入治疗以减少左向右分流,减轻心脏负荷,有利于左室心肌发育及心室逆重构。

关键词: 先天性心脏病; 心肌致密化不全; 介入治疗; 儿童

Abstract:  Objective To explore the safety and prognosis of interventional therapy for congenital heart disease (CHD) complicated with left ventricular non-compaction (LVNC) in children. Methods The clinical data of congenital heart disease complicated with myocardial densification in children treated from January 2016 to October 2017 were retrospective analyzed. The changes of non-compacted layer/compacted layer (N/C) ratio and cardiac function parameters measured by color Doppler echocardiography before and after cardiac interventional therapy were compared. The complications were recorded. Results A total of 25 children (9 boys and 16 girls) were included and the median age was 1 year (0.14~8 years). There were 22 cases of patent ductus arteriosus, 2 cases of atrial septal defect and 1 case of ventricular septal defect. The differences in left ventricular end-diastolic diameter (LVEDD) -Z value and N/C ratio at pre-operation and at postoperative 1, 6 and 12 months were statistically significant (all P<0.05), with the lowest value at 12 months after operation. The LVNC basically disappeared during follow-up in 6 children. However, there was no significant difference in left ventricular ejection fraction (LVEF) between these time points (all P>0.05). There was no correlation among N/C ratio, LVEDD -z value and LVEF value before and at 1, 6 and 12 months after operation (all P>0.05). The median postoperative follow-up was 19 months (12-27 months), and no adverse cardiovascular events or arrhythmias occurred during the follow-up. Conclusions For Children with CHD complicated with LVNC, when no contraindications exist, interventional therapy is recommended to reduce left to right shunt and cardiac overload. It is conducive to left ventricular myocardial development and ventricular reverse remodeling.

Key words: congenital heart disease; left ventricular non-compaction; interventional therapy; child