实时三维经胸超声心动图检测二尖瓣成形术前后左心房功能的变化及临床意义

目的:探讨实时三维经胸超声心动图检测左心房(LA)功能以评价二尖瓣成形术(MVR)疗效的价值。方法:选择87例二尖瓣关闭不全患者(病例组)分别在MVR术前及术后1 w、24 w采取实时三维经胸超声心动图检测LA的最大容积(maximum volume of LA,LAV_(max))、最小容积(the minimum volume of LA,LAV_(min))、收缩前容积(systolic volume,LAV_p)及射血分数(ejection fraction,LAEF)、被动射血分数(passive ejection fraction,LAPEF)及主动射血分数(active ejection fraction,LAAEF)等指标,并与同期80例健康志愿者作对照。结果:病例组术前LAV_(max)I、LAV_(min)I、LAV_pI、LAEF、LAPEF、LAAEF值与对照组比较差异有统计学意义(P0.05),术后1 w、24 w,LAV_(max)I、LAV_(min)I、LAV_pI、LAEF、LAPEF持续改善(P0.05),LAPEF无明显变化(P0.05)。术后24 w,LA严重扩张由术前58.6%降低到12.6%,67.8%发生LA重构。结论:实时三维经胸超声心动图显示MVR术后LA容积与功能好转,对评价MVR的疗效有一定价值。

Detection of the Changes of Left Ventricular Function before and after Mitral Valvuloplasty by Real Time Three Dimensional Transthoracic Echocardiography and Its Clinical Significances

ABSTRACT Objective: To evaluate the clinical value of real-time three-dimensional transthoracic echocardiography for detecting the left atrium (LA) function in mitral valvuloplasty (MVR). Methods: The maximum volume of LA(LAV _max ), minimum volume(LAV _min ), systolic volume(LAV _p ) and ejection fraction(LAEF), passive ejection fraction(LAPEF) and active ejection fraction(LAAEF) of 87 cases of patients with mitral regurgitation (case group) were examined by real time three-dimensional transthoracic echocardiography respec- tively before and at 1 week and 24 weeks after MVR, and compared with 80 healthy volunteers in the same period. Results: The preoper- ative LAV _max I, LAV _min I, LAV _p I, LAEF, LAPEF and LAAEF values between the case group and the control group were statistically signifi- cant (P<0.05), the LAV _max I, LAV _min I, LAV _p I, LAEF and LAPEF values from MVR 1w to 24w were continuously improvement (P<0.05), while the LAPEF values showed no obvious change (P>0.05). At 24 weeks postoperation, the proportion of severe LA dilatation de- creased from 58.6 % to 12.6 %, and LA remodeling was found 67.8 % cases. Conclusion: Real time three-dimensional transthoracic ech- ocardiography showed LA volume and functional improvement after MVR, which was of some value in evaluating the curative effect of MVR.