超声心动图对三尖瓣下移畸形术前诊断及术后疗效评价的作用

Echocardiographic diagnosis and evaluation in pre and post operation of Ebstein anomaly

目的探讨超声心动图诊断三尖瓣下移畸形(Ebstein anomaly)的准确性和对术后近期疗效的评价。方法8例行Ebstein anomaly手术的患者,术前均经超声心动图明确诊断,同时评价三尖瓣下移的程度、瓣叶发育情况及活动度、房化右心室的大小、三尖瓣反流程度及右心室功能等指标。术后随访和比较超声心动图变化及评价手术疗效。结果8例患者均有隔叶下移,三尖瓣环扩张和前叶发育异常并活动受限,伴后叶下移5例,三尖瓣中度以上反流6例,右心室功能减低1例,房化右心室大小为37mm×18mm^54mm×34mm。术中所见与术前检查基本一致。术后3~6个月进行超声心动图随访。结果显示:5例房化右心室基本消失,三尖瓣瓣叶基本回复到正常位置,3例房化右心室较前明显缩小,6例三尖瓣反流消失,所有患者三尖瓣环均明显缩小,右心室功能均正常。结论超声心动图对Ebstein anomaly术前诊断及术后疗效的评价均具有重要的作用。

Objective To evaluate the accuracy of echocardiography in diagnosing Ebstein anomaly and the early results after the operation. Methods Eight patients underwent operation of Ebstein anomaly were performed with echocardiography before the operation. The level of displacement of the tricuspid apparatus, the abnormalities and the degree of mobility of tricuspid, the size of atrialized right ventricle and severity of tricuspid regurgitation, right ventricular function were evaluated. All patients were followed-up by echocardiography, and the data of preoperation were compared with the that of post operation. Results The downward displacement of the hinge points involved all the septal and five posterior leaflets. All of the patients had enlarged tricuspid annulus anterior leaflets were redundant with abnormal movement. The size of atrialized right ventricle was 37mm × 18mm-54mm × 34mm. with tricuspid regurgitation（6 moderate, 2 mild）, one patient had decreased right ventricular function. The findings in operation were same with that of pre-operation echocardiography. During the follow-up of post-operation, the atrialized right ventricle in five patients disappeared, and the that of next three patients were obveriously smaller than the pre-operation. The regurgitation of tricuspid disappeared in 6 patients, and the tricuspid annulus diameter decreased remarkably. All the patients right ventricular function was normal. Conclusion Echocardiography is important in the diagnosis of Ebstein anomaly in pre-operation and the assessment of early results of post-operation.