Venous Flow Variation Predicts Preoperative Pulmonary Venous Obstruction in Children with Total Anomalous Pulmonary Venous Connection.
Venous Flow Variation Predicts Preoperative Pulmonary Venous Obstruction in Children with Total Anomalous Pulmonary Venous Connection.
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DOI：
10.1016/j.echo.2021.02.007
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Cohen MS
中科院分区：
文献类型：
--
作者：
White BR;Faerber JA;Katcoff H;Glatz AC;Mascio CE;Cohen MS
完全性肺静脉异位引流(TAPVC)术前识别肺静脉阻塞对指导治疗计划和风险预测具有重要意义。文献中没有标准化的超声心动图对梗阻的定义。基于绝对速度的定义受到技术限制和肺静脉回流变化的影响。我们开发了一种量化肺静脉血流变化的指标：肺静脉变异指数(PVVI)。我们的目的是证明它在定义梗阻方面的准确性。所有在我们机构接受TAPVC治疗的患者都得到了确认。复习超声心动图，测量肺静脉径路的最大血流速度(Vmax)、平均血流速度(Vean)和最小血流速度(Vmin)。PVVI定义为(Vmax-Vmin)/Vean。将这些指标与心导管术测量的压力进行比较。超声心动图测量在有和没有临床手术前梗阻的患者之间进行比较(定义为需要术前插管、基于导管的介入或在诊断的一天内进行手术)，以及通过胸部X光和乳酸酸中毒标志物发现的肺水肿。137例患者包括22例有导尿压力记录的患者。≥为4 mm Hg和4 mm Hg的患者的最大血流速度和平均血流速度无明显差异，而≥为4 mm Hg的患者PVVI值显著降低，最小血流速度明显升高。51例患者(37%)出现了术前梗阻的综合结果。临床有梗阻与无梗阻患者的绝对血流速度无明显差异，而有梗阻患者的PVVI明显降低。除最大血流速度外，所有指标均与肺水肿有关；没有一项指标与血气指标有关。我们开发了一种新的肺静脉血流定量测量方法，该方法优于传统的超声心动图测量方法。PVVI降低与导管术和临床术前梗阻测量的压差升高高度相关。这些结果应该有助于TAPVC患者的术前风险评估和诊断。
Identifying preoperative pulmonary venous obstruction in total anomalous pulmonary venous connection (TAPVC) is important to guide treatment-planning and risk prognostication. No standardized echocardiographic definition of obstruction exists in the literature. Definitions based on absolute velocities are affected by technical limitations and variations in pulmonary venous return. We developed a metric to quantify pulmonary venous blood flow variation: pulmonary venous variability index (PVVI). We aimed to demonstrate its accuracy in defining obstruction. All patients cared for with TAPVC at our institution were identified. Echocardiograms were reviewed, and maximum (Vmax), mean (Vmean), and minimum velocities (Vmin) along the pulmonary venous pathway were measured. PVVI was defined as (Vmax–Vmin)/Vmean. These metrics were compared to pressures measured by cardiac catheterization. Echocardiographic measures were then compared between the patients with and without clinical preoperative obstruction (defined as a need for preoperative intubation, catheter-based intervention, or surgery within one day of diagnosis), as well as pulmonary edema by chest X-ray and markers of lactic acidosis. 137 patients were included with 22 having catheterization pressure recordings. Maximum and mean velocity were not different between patients with catheter gradients ≥4 mmHg and <4 mmHg, while PVVI was significantly lower and minimum velocity higher in those with gradients ≥4 mmHg. The composite outcome of preoperative obstruction occurred in 51 patients (37%). Absolute velocities were not different between patients with and without clinical obstruction, while PVVI was significantly lower in patients with obstruction. All metrics except maximum velocity were associated with pulmonary edema; none were associated with blood gas metrics. We developed a novel quantitative metric of pulmonary venous flow, which was superior to traditional echocardiographic metrics. Decreased PVVI was highly associated with elevated gradients measured by catheterization and clinical preoperative obstruction. These results should aid risk assessment and diagnosis preoperatively in patients with TAPVC.
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影响因子：
2.3
作者：
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通讯作者：
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DOI：
10.1016/j.athoracsur.2012.03.006
发表时间：
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期刊：
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影响因子：
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