【摘要】 目的用核磁共振影像(MRI)测定不同手术阶段功能性单心室(FSV)心功能,探讨心功能变化原因及相关因素。方法2004年4月至2004年11月,41例FSV病儿分3组行MRI检查:I组(未手术者)24例;II组(双向腔肺动脉吻合术,BCPC后)9例;III组(全腔肺动脉吻合术,TCPC后)8例。6名健康儿为对照。比较各组舒张末容量指数(EDVI)、收缩末容量指数(ESVI)、心搏指数(SVI)、心肌质量指数(MassI)、心指数(CI)、EF和Mass/EDV。结果I组和II组的EDVI和ESVI显著大于对照;I组SVI显著大于III组和对照;I组CI显著大于其他组;II组和III组EF显著小于对照;前三组MassI显著大于对照;III组Mass/EDV显著大于其他组。结论FSV术前心功能表现与此期血流动力学处于高负荷状态一致。BCPC术和TCPC术后中远期心脏舒缩功能不全与舒张末期容量和心肌质量异常有关。MRI评价FSV心功能更具优势。更多还原

【Abstract】 Objective To evaluate the causes and the correlative factors of the change of heart function throughout the staged Fontan reconstruction assessed by magnetic resonance imaging. Methods 41 patients with functional single ventricle (FSV) in various stages of Fontan reconstructon were prospectively studied between April 2004 and November 2004. Patients were divided into 3 categories. Group I, included 24 pre-operation patients. Group II, included 9 patients after the Bidirectional cavopulmonary connection (BCPC) procedure (3.3 years). Group III, included 8 patients after the total cavopulmonary connection (TCPC) procedure (1.9 years). Control group, included 6 healthy children. All patients were studied with MRI. A software was used to manipulate the images and to obtain end-diastolic volume index (EDVI), end-systolic volume index (ESVI), ejection fraction (EF), stroke volume index (SVI) and ventricular mass index (MassI). Results There was significant difference in EDVI between group I, group III and control group. There was significant difference in EDVI between group II and group III and control group. ESVI in group I and group II was significant more than that in control group. SVI in group I was significant more than group III and control group. EF in group II and group III was significant less than control group. CI in group I was significant greater than other groups. MassI in three patients’ groups was significant greater than that in control group. M/V in group III was significant greater than other groups. Conclusion FSV has a high volume-loaded before the BCPC procedure, which is consistent with the physiology of pre-operation. Systolic and diastolic dysfunction after BCPC and TCPC procedure may due to the abnormality of Mass and EDV. Magnetic resonance imaging has superiority in evaluating ventricle performance of FSV.更多还原