ECHOCARDIOGRAPHIC MORPHOMETRY AND GEOMETRY OF THE LEFT-VENTRICULAR OUTFLOW TRACT IN FIXED SUBAORTIC STENOSIS
ECHOCARDIOGRAPHIC MORPHOMETRY AND GEOMETRY OF THE LEFT-VENTRICULAR OUTFLOW TRACT IN FIXED SUBAORTIC STENOSIS
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DOI：
10.1016/0735-1097(93)90563-g
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发表时间：
1993-11-01
影响因子：
24
通讯作者：
GEVA, T
中科院分区：
文献类型：
--
作者：
KLEINERT, S;GEVA, T
目标.本研究旨在通过超声心动图确定固定性主动脉瓣下狭窄儿童左心室流出道的形态学异常，并确定这些异常是否先于主动脉瓣下梗阻的发展。背景固定性主动脉瓣下狭窄通常在出生后第1年发生和进展，因此通常被视为后天性病变。虽然推测可能存在潜在的解剖学基础，但没有数据支持这一假设。方法.测定两组儿童的主动脉瓣环大小、二尖瓣-主动脉瓣分离、二尖瓣-左室间隔角和主动脉瓣覆盖程度。第1组包括35例首次超声心动图发现的孤立性主动脉瓣下狭窄患者，并与年龄和体重匹配的正常对照组（第1A组）进行比较。第2组包括23名室间隔缺损或主动脉缩窄或两者兼有的患者，他们在最初的超声心动图上没有主动脉瓣下狭窄，但随后发展为主动脉瓣下狭窄。将该组与年龄、体重和病变匹配的对照组（组2A）进行比较。结果与对照组相比，孤立性主动脉瓣下狭窄患者的二尖瓣主动脉瓣分离明显更宽（[平均值+/- SD] 5.1 +/- 1.3 vs. 3.4 +/- 0.9 mm，p < 0.001），更陡的椎间隔角（131 +/- 6度vs. 144 +/- 5度，p < 0.001）和夸大的主动脉覆盖（p < 0.05）。第2组患者在发生主动脉瓣下狭窄前的初始超声心动图中发现了类似的差异：二尖瓣-主动脉瓣宽分离（4.2 +/- 1.2 vs. 2.5 +/- 0.7 mm，p < 0.001），更陡的椎间隔角（132 +/- 7度vs. 145 +/- 7度，p < 0.001）和夸大的主动脉覆盖（p < 0.05）。结论.左心室流出道畸形的特征是二尖瓣-主动脉瓣分离较宽，主动脉过度覆盖和室间隔角较陡，存在于室间隔缺损或主动脉缩窄的儿童中，或两者同时存在，随后发展为主动脉瓣下狭窄。这些形态特征可用于超声心动图识别有发生固定性主动脉瓣下狭窄风险的患者。
Objectives. This study was designed to identify, by echocardiography, morphometric abnormalities of the left ventricular outflow tract in children with fixed subaortic stenosis and to determine whether these abnormalities precede the development of subaortic obstruction. Background. Fixed subaortic stenosis typically develops and progresses after the 1st year of life and is therefore often regarded as an acquired lesion. Although it has been speculated that there may be an underlying anatomic substrate, there are no data to support this hypothesis. Methods. The size of the aortic annulus, mitral-aortic valve separation, aorto-left ventricular septal angle and degree of aortic override were determined in two groups of children. Group 1 comprised 35 patients with isolated subaortic stenosis noted on initial echocardiogram who were compared with an age- and weight-matched normal control group (Group 1A). Group 2 comprised 23 patients with ventricular septal defect or coarctation of the aorta, or both, who had no subaortic stenosis on initial echocardiogram but who developed it subsequently. This group was compared with an age, weight- and lesion-matched control group (Group 2A). Results. Compared with control subjects, patients with isolated subaortic stenosis had a significantly wider mitral aortic separation ([mean +/- SD] 5.1 +/- 1.3 vs. 3.4 +/- 0.9 mm, p < 0.001), a steeper aortoseptal angle (131 +/- 6 degrees vs. 144 +/- 5 degrees, p < 0.001) and an exaggerated aortic override (p < 0.05). Similar differences were found on initial echocardiogram in Group 2 patients before development of subaortic stenosis: wider mitral-aortic separation (4.2 +/- 1.2 vs. 2.5 +/- 0.7 mm, p < 0.001), a steeper aortoseptal angle (132 +/- 7 degrees vs. 145 +/- 7 degrees, p < 0.001) and an exaggerated aortic override (p < 0.05). Conclusions. A left ventricular outflow tract malformation characterized by a wider mitral-aortic separation, an exaggerated aortic override and a steeper aortoseptal angle are present in children with ventricular septal defect or coarctation of the aorta, or both, who subsequently develop subaortic stenosis. These morphometric features can be used to identify by echocardiography patients who are at risk for developing fixed subaortic stenosis.