Left ventricular function assessed with echocardiography and myocardial perfusion assessed with scintigraphy under dipyridamole stress in pediatric patients after repair for anomalous origin of the left coronary artery from the pulmonary artery.
Left ventricular function assessed with echocardiography and myocardial perfusion assessed with scintigraphy under dipyridamole stress in pediatric patients after repair for anomalous origin of the left coronary artery from the pulmonary artery.
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在左冠状动脉异常起源于肺动脉的儿科患者修复后，通过超声心动图评估左心室功能，并在双嘧达莫应激下通过闪烁扫描评估心肌灌注。
DOI：
10.1016/s0022-5223(19)33717-1
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发表时间：
1993
影响因子：
6
通讯作者：
K. Bühlmeyer
中科院分区：
文献类型：
--
作者：
H. Stern;U. Sauer;D. Locher;R. Bauer;H. Meisner;F. Sebening;K. Bühlmeyer
本文对23例因左冠状动脉起源地与肺动脉异常而行手术的患者进行二维超声心动图及铊201灌注显像复查。术后随访0.6 ~ 16.2年（中位2.9年）。23例患者中有22例通过左冠状动脉植入主动脉（n = 8）或左锁骨下动脉与左冠状动脉吻合（n = 14）建立了双冠状动脉系统。只有一名患者结扎了左冠状动脉。在压力测试中，23例患者中有20例在10分钟内每公斤体重输注0.8 mg双嘧达莫。大剂量双嘧达莫使平均心率（98.1±27.1 ~ 122.3±19.2次/min， p < 0.001）和左室射血分数（54.8%±11.8% ~ 61.3%±12.5%,p < 0.05）升高，左室舒张末期容积指数（38.8±26.7 ~ 29.9±8.3 ml/m2, p < 0.005）降低。静息时，只有1例患者左心室尺寸异常，其与左冠状动脉的吻合被证实闭塞，随后的血管造影显示。二维超声心动图显示19例左室功能正常，3例左室功能受损（均为左室主要结构异常，如左室动脉瘤、吻合口闭塞或二尖瓣假体）。术前心电图显示r波丢失的患者在随访时左心室容积更大（69.2±56.5 ml/m2 vs 32.4±9.6 ml/m2, p < 0.07）。20例患者中有10例铊201灌注扫描正常。20例患者中有9例观察到铊201永久灌注显示的缺损，并确定为心肌疤痕。3例患儿在双嘧达莫应激下出现短暂灌注缺损，休息时再分布，其中2例患儿还存在永久性铊201缺损。3例患者在双嘧达莫应激期间均无心绞痛样症状或S-T段改变。然而，在单例左冠状动脉结扎的患者中，双嘧达莫输注左心室射血分数严重下降。其余2例患者在应激下的超声心动图左心室功能正常，超声心动图显示心肌缺血的诊断必须受到质疑。铊201 -灌注
Twenty-three patients who underwent operation for anomalous origin of the left coronary artery from the pulmonary artery were reexamined with two-dimensional echocardiography and thallium 201 perfusion imaging. Follow-up studies were performed 0.6 to 16.2 years (median 2.9 years) after operation. In 22 of 23 patients, a two coronary artery system had been established by implantation of the left coronary artery into the aorta (n = 8) or by anastomosis of the left subclavian artery with the left coronary artery (n = 14). The left coronary artery had been ligated in only one patient. For stress testing, 0.8 mg dipyridamole per kilogram body weight was infused in a 10-minute period in 20 of the 23 patients. High-dose dipyridamole infusion increased mean heart rate (98.1 ± 27.1 to 122.3 ± 19.2 beats/min, p < 0.001) and mean left ventricular ejection fraction (54.8% ± 11.8% to 61.3% ± 12.5%, p < 0.05) and decreased left ventricular end-diastolic volume index (38.8 ± 26.7 to 29.9 ± 8.3 ml/m2, p < 0.005). At rest, left ventricular dimensions were abnormal in only one patient, in whom the anastomosis with the left coronary artery proved to be occluded, as seen with subsequent angiography. Left ventricular function seen with two-dimensional echocardiography was normal in 19 patients and was compromised in 3 (all of whom had major structural anomalies of the left ventricle, such as left ventricular aneurysm, occlusion of the anastomosis, or mitral valve prosthesis). Patients with R-wave loss as seen with preoperative electrocardiography tended to have larger left ventricular volumes at follow-up (69.2 ± 56.5 ml/m2versus 32.4 ± 9.6 ml/m2, p < 0.07). Ten of 20 patients had normal thallium 201–perfusion scans. In 9 of 20 patients defects revealed by permanent thallium 201–perfusion were observed and determined to be myocardial scars. Transient perfusion defects under dipyridamole stress with redistribution at rest occurred in three children, two of whom also had permanent thallium 201 defects. None of the three patients had angina-like symptoms or S-T segment changes during dipyridamole stress. Left ventricular ejection fraction, however, decreased severely during dipyridamole infusion in the single patient with ligature of the left coronary artery. The two remaining patients had normal echocardiographic left ventricular function under stress, and the diagnosis of myocardial ischemia as seen with scintigraphy must be questioned. Thallium 201–perfusion