A novel parameter for pulmonary blood flow during palliative procedures: velocity time integral of the pulmonary vein.
A novel parameter for pulmonary blood flow during palliative procedures: velocity time integral of the pulmonary vein.
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姑息治疗期间肺血流的一个新参数：肺静脉的速度时间积分。
DOI：
10.1093/ejcts/ezy465
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Masanori Tsuchida
中科院分区：
文献类型：
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作者：
Shuichi Shiraishi;Keiko Bamba;Ai Sugimoto;Masashi Takahashi;Masanori Tsuchida
目的先天性心脏缺陷姑息治疗的主要目标是获得足够的肺血流量（PBF），但术中准确的肺血流量评估有时是困难的。本初步研究的目的是探讨在姑息治疗过程中经食管超声心动图（TOE）测量的肺静脉速度时间积分（PV-VTI）作为PBF参数的有效性。方法回顾性分析本中心2011年至2017年63例接受缓和治疗的患者（18例双侧肺动脉带束术，22例肺动脉主动脉带束术，23例全身-肺动脉分流术）术中经TOE测量PV-VTI的病例史。排除低体重婴儿、使用体外循环的病例和解剖上难以测量的病例。结果双侧肺动脉束带组和主肺动脉束带组术后4个肺静脉孔的spv - vtis均显著降低，全身-肺动脉分流组术后即刻spv - vtis升高。左右肺静脉流速时间积分与动脉血氧饱和度呈显著相关（r= 0.564、0.703）。9例患者（6例双侧肺动脉束带和3例全身-肺动脉分流）由于PBF不足需要计划外的早期再手术；他们的pv - vti与不需要再手术的患者有显著差异。术后未发生与TOE相关的主要并发症。结论在姑息治疗过程中，TOE测量的PV-VTI反映了PBF的变化，有助于识别因PBF不足而早期再手术风险较高的患者。该参数可能是评估术中PBF的一个有用的附加工具。
OBJECTIVESThe main goal of palliative procedures for congenital heart defects is adequate pulmonary blood flow (PBF), but precise intraoperative PBF evaluation is sometimes difficult. The purpose of this preliminary study was to investigate the usefulness of velocity time integral of the pulmonary vein (PV-VTI) measured by transoesophageal echocardiography (TOE) at the time of palliative procedure as a parameter for PBF.METHODSCase histories of 63 patients who underwent palliative procedures (bilateral pulmonary artery banding in 18 patients, main pulmonary artery banding in 22 patients and systemic-to-pulmonary artery shunt in 23 patients) and whose intraoperative PV-VTI was measured by TOE from 2011 to 2017 at our centre were retrospectively reviewed. Low-body-weight infants, cases in which cardiopulmonary bypass was used and cases that were anatomically difficult to measure were excluded.RESULTSPV-VTIs measured at 4 orifices of the pulmonary veins were all significantly decreased in both the bilateral pulmonary artery banding and main pulmonary artery banding groups and increased in the systemic-to-pulmonary artery shunt group immediately after the procedure. There were significant correlations between the velocity time integrals of both right and left pulmonary veins and arterial oxygen saturation (r= 0.564 and 0.703). Nine patients (6 bilateral pulmonary artery banding and 3 systemic-to-pulmonary artery shunt) required unplanned early reoperation due to inadequate PBF; their PV-VTIs were significantly different from those of patients not requiring reoperation. No major complications related to TOE occurred postoperatively.CONCLUSIONSThe PV-VTI measured by TOE during palliative procedures reflected the change of PBF and could help identify patients at higher risk of early reoperation due to inadequate PBF. This parameter may be a useful additional tool for evaluating intraoperative PBF.