实时三维超声心动图评价室间隔缺损封堵术对左室功能及其收缩同步性的影响

The influence of percutaneous closure of ventricular septal defect on left ventricular function and systolic synchrony assessed by real-time three-dimensional echocardiography

目的运用实时三维超声心动图评价室间隔缺损患者行介入封堵术对左心室功能及其收缩同步性的影响。方法对36例室间隔缺损患者行介入封堵术,并于术前、术后3d、术后6个月进行三维超声心动图检查,记录左室舒张末容积(LVEDV)、左室射血分数(LVEF)、左室每搏输出量(LVSV)、左室最大射血速率(PER)、左室最大充盈速率(PFR)、左室16节段达到最小收缩容积时间的标准差值和最大差值被标准化为心动周期的百分比(Tmsv16-SD%、Tmsv16-Dif%)。并同时检查30例健康人作为对照组。结果与对照组相比,封堵组术前左室舒张末期内径(LVEDd)增大(P<0.05),LVEDV、LVEF、LVSV、PER、PFR均显著大于正常(P<0.01)。封堵术后3d即有明显降低,至术后6个月时,上述所有三维心功能指标与对照组差异均无统计学意义(P>0.05)。PER/EDV术前高于对照组,封堵术后逐渐降低,至术后6个月,与术前相比差异有统计学意义(P<0.05),而PFR/EDV封堵前后比较及与对照组比较,差异无统计学意义(P>0.05)。封堵术前后及与正常对照组相比,左室同步性指标Tmsv16-SD%、Tmsv16-Dif%差异无统计学意义(P>0.05),但从两个直观的"牛眼图"上显示封堵治疗后患者基底部前间隔、后间隔节段出现收缩延迟和活动减弱,考虑与金属封堵器的影响有关。结论由于室缺异常心室水平分流造成的左室高负荷、高动力状态在封堵治疗6个月后明显改善回复到正常水平。金属封堵器虽可引起部分节段收缩异常,但对左心室整体同步性运动未造成明显影响。

Objective To evaluate the influence of percutaneous closure of ventricular septal defect（VSD） on left ventricular function and systolic synchrony using real-time three-dimensional echocardiography.Methods Using RT-3DE,the three-dimensional parameters were repeatedly measured in thirty-six patients with VSD before closure,in 3rd day and 6th month after closure.The end-diastolic volume（EDV） ,end-systolic volume（ESV） ,left ventricular ejection fraction（LVEF） ,left ventricular stroke volume（LVSV） ,left ventricular peak ejection rate（PER） ,left ventricular peak filling rate（PFR） ,the time of minimal systolic volume of 16-segmental＇standard deviation（Tmsvl6SD% ） and maximum difference （Tmsvl6-Dif% ） were recorded.Thirty normal subjects were enrolled as control group.Results Compared with the control group,the study group before closure,left ventricular end-diastolic diameter （LVEDd） was enlarged （P 0.05） ,LVEDV,LVEF,LVSV,PER,PFR were significantly higher than normal （P 0.01） .Three days after operation,there was obvious decline in these three-dimensional cardiac function indices.By 6 months after transcatheter closure,changes in LV volume and function which caused by VSD disappeared.PER/EDV was higher in VSD patients than the control group.Six months after closure,it decreased to normal.Compared with the control group,PFR/EDV,before and after occlusion the difference was not statisticaly sig-nificant （P 0.05） .Before and after occlusion and compared with control group,left ventricular synchrony indexes Tmsv16-SD% 、Tmsv16-Dif% ,the difference was not statistical significant （P 0.05） ,but the two intuitive ＂the bull eye＂maps showed that basal anteroseptal and basal inferoseptal segments systolic timing delayed and systolic excursion attenuated,we considered it caused by the impact of the occluder.Conclusion The left ventricular high-preload,high-power state caused by the ventricular level abnormal shunt of VSD returned to normal after 6 months of transcatheter therapy.Although the metal occluder may be caused some segments systolic abnormalities,overall left ventricular synchronicity does not be significantly affected.