超声瞬时波强技术对室间隔缺损封堵前后左心室功能的评价

Evaluation of left ventricular function before and after closing ventricular septal defects using wave intensity

目的探讨超声瞬时波强（WI）技术评价先天性心脏病室间隔缺损（VSD）患者封堵前后左心室功能变化的价值。方法病例组VSD封堵患者42例，对照组350例健康志愿者。病例组分别于封堵术前1d、术后3d、3个月行超声心动图检查。首先应用常规超声心动图检测左室内径及常规收缩功能指标。再用WI技术评价VSD患者封堵前后右颈总动脉WI指标的变化情况。WI技术指标采用两个正向峰W1、W2、负向峰面积（NA）及心电图R波顶点到W1峰顶点的时间（R-1st）、W1顶点到W2顶点的时间（1st2nd），并计算R-1st、1st-2nd的心率校正后时间R-1stcorrect和1st-2ndcorrect。结果VSD封堵前左室内径、射血分数（EF）、短轴缩短率（FS）和心输出量（CO）明显增大；封堵后3d左室内径与CO较术前明显变小，EF和FS无明显变化；封堵后3个月上述各指标较术前明显变小。VSD封堵前W1值明显增高，1st-2nd减低，余指标无明显变化。VSD封堵后3d与术前比较各指标均无明显变化。术后3个月与术前及术后3d比较，W1减低，1st-2nd增大，与对照组比较无明显差异。结论超声WI技术有助于评估VSD患者封堵前后左心室功能的变化。

Objective To investigate the clinical value of wave intensity（WI） in assessing the changes of left ventricular function after closing ventrieular septal defects （VSD）. Methods Forty-two patients with VSD were selected in case group. Three hundred fifty healthy participants served as a baseline control group. Each patient underwent echocardiography at 1 day before and 3 days and 3 months after dosing VSD. The size of left ventricle and left ventricular ejection fraction （EF）, fraction of shortening （FS） and cardiac output （CO） were measured by conventional echocardiagraphy. The index of WI, including W1, W2, NA, R-1st and 1st 2nd of right common carotid artery（CCA） were used to evaluate changes of left ventricular function before and after closing VSD. The R-1st and lst-2nd corrected by heart rate were calculated. Results The size of left ventricle and the value of EF,FS and CO increased significantly in VSD patients before closing than controls. At 3 days after closing, the size of left ventricle and CO decreased, however,EF and FS had no statistical significance. At 3 months after surgery, all above index were higher than that before surgery and had no significance compared with control group. Before closing VSD,W1 increased and 1 st-2nd decreased significantly than controls. The value of W2, NA, R-1st,R-1st and 1st-2nd had no changes. The above parameters of 3 days after closing did not differ significantly from that before surgery. At 3 months, WJ reduced and 1st-2nd recovered and reached the normal values. Conclusions WI technique is useful for evaluating the changes of left ventricular function before and after closing VSD.