巨大左心室主动脉瓣置换术后的超声随访

Left ventricular geometry and systolic performance follow-up of echocardiography after aortic valve replacement in patients with giant left ventricle

目的动态观察主动脉瓣置换术后巨大左心室几何形态和功能的变化。方法回顾性分析36例主动脉瓣关闭不全或以关闭不全为主合并巨大左心室患者（巨大左心室组）换瓣术前，术后2周、6个月、1年、2年的超声心动图随访资料。与18例同期行超声心动图检查排除心血管疾病者（对照组）比较。结果巨大左心室组主动脉瓣重度关闭不全引起的巨大左心室主要以离心性扩大为主，术后2周左心室舒张末内径、收缩末内径、长径即呈现缩小趋势，与术前比较差异有统计学意义（P〈0．05），术后1年缩小最显著，与术后2周和术后6个月比较差异均有统计学意义（P〈0．01），至术后2年这种趋势减缓或消失，与术后1年比较差异无统计学意义（P〉0．05），但左心室舒张末内径、收缩末内径与对照组比较差异仍有统计学意义（P〈0．05）。左心室后壁厚度在术后1年基本恢复正常，与对照组比较差异无统计学意义（P〉0．05）。左室射血分数在术后2周与术前比较无变化，随后逐渐恢复，至术后1年多数能恢复正常，与对照组比较差异无统计学意义（P〉0．05）。结论对于主动脉瓣关闭不全或以关闭不全为主的患者，巨大左心室一旦形成，形态则较难完全逆转。建议尽早手术治疗。左心室功能的恢复优于形态的恢复，恢复的最佳时期为手术后1年，应该加强该时期的随访和治疗。

Objective To observe the dynamic change of left ventricular geometry and systolic function after aortic valve replacement （AVR） in patients with giant left ventricle （GLV）. Methods The retrospective analysis of echecardiography of 36 cases with GLV undergoing AVR for aortic regurgitation between June 1995 and January 2006,the data of left ventricular geometry and systolic function. Results All patients survived after aortic valve replacement. The dilation of left ventricle caused by severe chronic aortic regurgitation was eccentrically enlarged and reduced progressively and was more significantly 1 year after AVR than 2 weeks and 6 months after AVR （P〈 0.01 ）. Up to 2 years after AVR, the geometry of GLV was no significantly change contrasting to that in 1 year after AVR （P 〉 0.05 ）. However, left ventricular ejection fraction （LVEF）, fraction shortening （LVFS） and posterior wall （LVPW） of majority cases could restore completely at 1 year after AVR. Conclusions Left ventricular geometry reversal is difficult for those patients with GLV result from aortic regurgitation. Early operation should be advised. Restoration of geometry prior to systolic performance,optimum schedule is 1 year of postoperation. Thereby follow-up treatment should be strengthened at this period.