Application Of Echocardiography In Evaluating Cardiac Function And Global Myocardial Perfusion In Neonates

First part:Evaluation of cardiac function in neonates by two-dimensional speckle tracking imaging combined with Doppler echocardiographyObjective:To investigate the global and regional left ventricular function in normal and left-to-right shunt congenital heart disease(CHD)neonates by two-dimensional speckle tracking technique combined with Doppler echocardiography.Methods:From Sept 2018 to Feb 2019 in our hospital,36 cases of non-CHD newborns were selected as normal group,and 58 cases of left-to-right shunt CHD(14 cases of PDA,11 cases of VSD,33 cases of ASD)were selected as CHD group.The left ventricular ejection fraction(EF),fractional shortening(FS),mitral annular systolic displacement(MAPSE),TDI-Tei index were obtained,and the two-dimensional dynamic images of parasternal left ventricular short-axis basal,papillary muscle,apical level,apical four-chamber,three-chamber,and two-chamber views were stored for three consecutive cardiac cycles.The peak systolic longitudinal strain(LS)and peak systolic radial strain(RS)of each segment of the left ventricle were obtained and the mean peak systolic radial strain(aRS)and mean peak systolic longitudinal strain(aLS)of the basal,middle,and apical segments of the left ventricle were calculated by QLAB software analysis.To study the left ventricular global function and regional myocardial radial and longitudinal strain in normal newborns.The normal control group was established for children with PDA,ASD,and VSD,respectively,so that there was no statistical difference in age,gestational age,birth weight,and BSA between them and the control group.The differences in ventricular global function and myocardial strain between the CHD group and its normal control group were compared.Results:(1)The absolute value of aRS was larger than that of aLS in all neonates(CHD group and normal group).(2)In the normal group,the LVDd,LVSd,and FS of term infants were higher than those of preterm infants,and the aRS-bas,aRS-mid,and aRS-api of the left ventricle were higher than those of preterm infants,and the differences were statistically significant(P<0.05).(3)The peak systolic radial strain(aRS-bal)in the basal segment of the left ventricle was correlated with heart rate(r=0.362)in the normal group,the peak systolic radial strain(aRS-mid)in the middle segment of the left ventricle was correlated with birth weight(r=-0.353),age(r=-0.356),and BSA(r=-0.336),and the peak systolic radial strain(aRS-api)in the apical segment was correlated with birth weight(r=-0.350),gestational age(r=-0.355),and BSA(r=-0.479),P<0.05.(4)Compared with the normal control group,the newborns in the VSD group had significantly higher heart rate,higher LVDd,LVSd,and TDI-Tei values,and lower left ventricular aRS-bas,aRS-mid,aRS-api,and aLS-mid(P<0.05).(5)There was no significant difference in left ventricular global function index and myocardial strain between PDA group and ASD group and normal control group(P>0.05).Conclusion:(1)The absolute value of aRS in left ventricular myocardium is larger than that of aLS.(2)There is a correlation between aRS-bal and heart rate in normal newborns,between aRS-mid and birth weight,age,and BSA,and between aRS-api and birth weight,gestational age,and BSA(P<0.05).Neonatal RS correlates the best with birth weight and BSA,and myocardial strain increased with neonatal growth and development.(3)VSD affects the global function of the left ventricle and regional myocardial motion.TDI-Tei and 2D-STI are effective methods for early detection of neonatal cardiac dysfunction.(4)PDA and ASD had no significant effect on left ventricular global function and regional myocardial strain.Second part:Evaluation of global myocardial perfusion in neonates by transthoracic echocardiographyObjective:To observe and measure the coronary sinus of normal newborns and newborns with left-to-right shunt CHD by transthoracic echocardiography(TTE),and analyze the factors affecting the diameter and blood flow of the coronary sinus,to evaluate global myocardial perfusion in neonates.Methods:From Sept 2018 to Feb 2019 in our hospital,36 cases of non-CHD newborns were selected as normal group,and 58 cases of left-to-right shunt CHD(14 cases of PD,11 cases of VSD,33 cases of ASD)were selected as CHD group.The inner diameter of the coronary sinus and the blood flow spectrum were obtained,and the blood flow velocity time integral(VTI)was traced to calculate the blood flow(Q).To study the ultrasonic manifestation of coronary sinus diameter and blood flow in normal newborns.The normal control group was established for children with PDA,ASD,and VSD,respectively,so that there was no statistical difference in age,gestational age,birth weight,and BSA between them and the control group.The differences in CS inner diameter and blood flow between the CHD group and its normal control group were compared.Results:(1)There were significant differences in the diameter and blood flow of the coronary sinus between the premature and full-term infants in the normal group(P<0.05);(2)The maximum diameter(Dmax)and minimum diameter(Dmin)of the coronary sinus in the normal group were correlated with birth weight,gestational age and BSA,velocity time integral(VTI)was correlated with BSA,blood flow(Q)was correlated with birth weight,gestational age,age,BSA and heart rate.(3)The heart rate,peak diastolic blood flow(VD),velocity time integral(VTI)and blood flow(Q)of the newborns in the ventricular septal defect(VSD)group were higher than those in the control group(P<0.05).Conclusion:(1)The global myocardial perfusion in neonates increase with the an increase of BSA after birth.(2)The global myocardial perfusion in neonates increase in the ventricular septal defect group,and the heart function is in compensatory state.The measurement of coronary sinus diameter and blood flow by TTE is of great significance in analyzing global myocardial perfusion and assessing neonatal heart function compensation in neonates.(3)PDA and ASD had no significant effect on global myocardial perfusion in neonates.(4)Assessment of coronary sinus blood flow by echocardiographic is a potential indicator of neonatal myocardial perfusion.