Abstract
Objective. To obtain data on the mass of the heart, diameters of valves and thickness of the ventricular myocardium in patients with Taussig–Bing anomaly (TBA) with different morphological variants of defects.
Material and methods. During the study morphometry of 30 heart specimens was performed. Results of morphometry of valves, wall thickness of the right (RV) and left (LV) ventricles were compared with reference data published by D.M. Schultz, D.A Giordano (1962) and the index Z-score were calculated. The following issues were studied: whether the valve size depends on gender, aortic obstruction, type of transposition of the great arteries (GA), stage of pulmonary hypertension (PH) according to Heath–Edwards classification and additional ventricular septal defects (AVSD). Statistical processing included dispersion, multivariate, regression and correlation analyses using the SPSS 15.0 software.
Results. Significant size increase of the valve of pulmonary trunk compared with its individual normal value (p=0.02) was detected. In presence of the aortic obstruction the diameter of the tricuspid valve was reduced (p=0.049) and in presence of multilevel aortic stenosis the diameter of the aortic valve was reduced (p<0.028). Gender, transposition of the great arteries and additional ventricular septal defects do not affect the size of the heart valves. Regression equations of the relationship between the diameters of the heart valves and anthropometric data were created. RV myocardial thickness in 84% cases significantly (p<0.001) exceeded the individual normal value (Z-score > 2), LV myocardial thickness in 90% cases corresponded to the age norm. High correlation (r=0.85) between the values of the RV and LV myocardial thickness was shown. According to the statistical analysis the gender, anatomic peculiarities of pathology and associated defects do not affect the ventricular myocardial thickness.
Conclusion. Quantitative assessment of the heart and its structures in TBA patients allowed to determine three distinctive signs of pathology: increase of the mass of the heat (87% cases), RV myocardial thickness (84% cases) and the diameter of the pulmonary valve (52% cases) relative to the normal values. LV myocardial thickness, diameters of the atrioventricular and aortic valves in most cases corresponded to normal values. Independent factors for the heart mass increase in TBA patients were: the degree of morphological changes of the pulmonary vessels (III–IV grade according to Heath–Edwards classification) and older age [ME, 95% CI = 5.9 years (1.87; 9.42)]. Created mathematical equation and established indexed values of the mass of the heart allow to calculate predictive value of this parameter in TBA patients and optimize dose of cardioprotectors and cardiotropic drugs. Progressive and significant increase of the mass of the heart during natural course of the disease in TBA patients indicates the need for early surgical correction of this defect.
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