中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

肺动脉瓣环占比:法洛四联症根治术跨瓣补片的预测指标

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目的 提出新的预测指标——肺动脉瓣环占比,即肺动脉瓣环直径与主动脉瓣环直径和肺动脉瓣环直径之和的比值,能否较 z 值更好地指导手术方式的选择。 方法 回顾性分析广东省人民医院 2016 年 1 月至 2018 年 1 月,行法洛四联症一期根治术的 254 例患者。将其分为跨瓣补片组和非跨瓣补片组,均于心脏 CT 上测量肺动脉瓣环和主动脉瓣环直径,并通过统计学方法计算出需行跨瓣补片的肺动脉瓣环占比的临界值。 结果 总共 254 例患者纳入本研究,其中 164 例(64.6%)进行了跨瓣补片修补。跨瓣组肺动脉瓣环占比和 z 值均小于非跨瓣组(肺动脉瓣环占比:0.29±0.06 vs. 0.36±0.06,P<0.000 1;z 值:–4.05±2.13 vs. –2.06±1.84,P<0.000 1)。通过 ROC 曲线分析,肺动脉瓣环占比分界值为 0.353(AUC 0.781;95%CI:0.725~0.831),z 值分界值为–2.13(AUC 0.766;95%CI:0.709~0.817)。表明肺动脉瓣环占比是有效且简便易行的手术方式评估方法。 结论 本研究表明,肺动脉瓣环占比是有效的评估跨瓣与否法的指标,并可简单易行地应用于临床实践。

Objective To propose a new predictive index, the ratio of pulmonary valve annulus, which is the proportion of pulmonary valvular annulus size to total size of aortic valvular annulus and pulmonary valvular annulus to better guide the choice of surgical approach than the value of z. Methods A retrospective analysis was made of 254 patients who underwent total correction of tetralogy of Fallot in Guangdong General Hospital between January 2016 to January 2018. The patients were categorized into two groups, a transannular patch (TAP) group and a non-TAP group. The sizes of pulmonary and aortic valvular annulus were evaluated in each group, and the proportion of pulmonary valvular annulus cutoff values for TAP were calculated. Results In total, 164 patients (64.6%) required TAP. Both proportion of pulmonary valvular annulus and z-scores were smaller in the TAP group than in the non-TAP group (0.29±0.06vs. 0.36±0.06, P<0.000 1; –4.05±2.13vs. –2.06±1.84, P<0.000 1, respectively). In receiver operating characteristics analyses, proportion of pulmonary valvular annulus and thez-score cutoff values were 0.353 (area under the curve 0.781; 95%CI 0.725–0.831) and –2.13 (area under the curve 0.766; 95%CI 0.709–0.817), respectively, demonstrating that the proportion of pulmonary valvular annulus was a more powerful diagnostic tool as a predictor of TAP. Conclusion Our results suggest that the proportion of pulmonary valvular annulus is a effective predictor for TAP and can be easily applied to clinical practice.

关键词: 法洛四联症; 跨瓣补片; 肺动脉瓣环; z; 肺动脉瓣环占比

Key words: Tetralogy of Fallot; transannular patch; pulmonary valvular annulus; z-score; proportion of pulmonary valvular annulus

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