多普勒组织成像评价小儿心脏移植术后心功能

目的用超声心动图二维、M型、彩色多普勒及脉冲多普勒组织成像(PW-DTI)等方法对小儿心脏移植术后非排异期心脏的结构、形态、血流、功能等状态进行综合评价，重点探讨PW-DTI对小儿心脏移植术后非排异期心功能评价的意义。方法移植组和对照组各36例，应用超声心动图、PW-DTI测量左室舒张末期内径，室间隔厚度，左室后壁厚度，左室质量，左室短轴缩短率，二、三尖瓣前向血流舒张早、晚期峰值速率及心率；将PW-DTI取样容积置于二尖瓣瓣环水平左室侧壁、室间隔及三尖瓣环水平右室壁采样，获取收缩期和舒张早、晚期PW-DTI运动速度曲线。结果移植组的所有PW-DTI速度曲线参数均较对照组低。二尖瓣瓣环水平左室侧壁舒张早期峰值速率，室间隔及三尖瓣环收缩期峰值速率，舒张早、晚期峰值速率与对照组差异有显著性意义；而其他指标移植组与对照组基本相同。结论PW-DTI速度曲线参数的结果提示心脏移植术后非排异期患儿在常用的心功能指标测值正常时，已存在右室收缩、舒张功能及左室舒张功能的减低，以右心功能减低为明显。PW-DTI是一种敏感、简便的测量小儿心脏移植后左、右心功能的方法．

Cardiac function evaluated by Doppler tissue imaging in pediatric heart transplant patients

Objective To quantify abnormalities in mitral and tricuspid annular systolic and diastolic velocities as an indicator of left and right ventricular dysfunction in pediatric heart transplant patients without biopsy evidence of active cellular rejection.Methods Pulse Doppler tissue imaging was performed and velocities recorded during systole,early and late diastole at the mitral annulus,septum and tricuspid annulus in 36 heart transplant patients and 36 children in a control group with normal hearts.Left ventricular size,left ventricular septal and posterior wall thickness,left ventricular mass,short fraction, mitral and tricuspid inflows were also measured.Results All the DTI data in heart transplant patients were lower than those in control group.The early diastolic velocity in mitral annulus,early and later diastolic velocities and systolic velocities in septum and tricuspid annulus were reduced significantly compared with those in the normal group(P< 0.05).Left ventricular size,left ventricular septal and posterior wall thickness,left ventricular mass,shortening fraction,mitral inflow data showed no significant difference compared with those in the normal group (P> 0.05).Conclusions Pulse Doppler tissue velocities demonstrates that the left ventricular diastolic function,right ventricular systolic and diastolic function are abnormal in children after heart transplantation without biopsy evidence of active rejection.