实时三维超声心动图评价风湿性心脏病二尖瓣狭窄伴窦性心律患者经皮球囊扩张术左房功能

Assessment of left atrial function in patients with rheumatic mitral stenosis and sinus rhythm before and after percutaneous balloon mitral valvuloplasty by real time three-dimensional echocardiography

目的:探讨实时三维超声心动图(RT-3DE)评价风湿性心脏病二尖瓣狭窄(MS)合并窦性心律患者经皮球囊扩张术(PBMV)前后左房功能的价值。方法:采用RT-3DE对30名正常志愿者和30例MS合并窦性心律患者(PBMV术前、术后)测量并计算左心房最大容积指数(LAVmaxI)、左心房最小容积指数(LAVminI)及左心房收缩前容积指数(LAVpreI),左房总射血容量指数(TASVI)、左房被动射血容量指数(PASVI)、左房主动射血容量指数(AASVI),左房整体射血分数(LAEF)、左房被动射血分数(LAEFpassive)、左房主动射血分数(LAEFactive)。分析它们与二尖瓣口面积(MVA)、平均跨瓣压差(MMG)的相关性。结果:①MS患者LAVmaxI、LAVminI、LAVpreAI明显高于正常对照组,PBMV术后下降(P<0.05);MS患者PASVI、TASVI明显低于正常组,而AASVI明显高于正常组(P<0.05),PBMV术后PASVI增加、AASVI降低(P<0.05),TASVI接近于正常组(P>0.05)。MS患者术前LAEFpassive、LAEFactive、LAEF低于正常对照组,术后明显增加(P<0.05)。②PBMV术前后左房容积及功能参数改变量与MVA、MMG改变量呈一定相关关系(P>0.05)。结论:RT-3DE可准确定量评价MS合并窦性心律患者PBMV术前、术后左心房功能。

Objective： To evaluate left atrial（LA） function in patients with rheumatic mitral stenosis（MS） and sinus rhythm before and after percutaneous balloon mitral valvuloplasty（PBMV） by real time three-dimensional echocardiography（RT-3DE）.Methods： Thirty healthy volunteers and thirty patients with MS and sinus rhythm who underwent PBMV were examined by RT-3DE.LA voulme indices including： maximum,minimum,pre-atrial contraction LA volume index（LAVmaxI,LAVminI,LAVpreAI）,LA function indices including total atrial,passive atrial,active atrial stroke volume index（TASVI,PASVI,AASVI） and total,passive,active atrial ejection fraction（LAEF,LAEFpassive,LAEFactive） were measured and calculated.Relationships between the changes of LA volume and function indices and the changes of mitral valve area（MVA） and mean mitral gradient（MMG） were analyzed.Results： ①LA volume indices were significantly greater in patients with MS than the controls,and the indices were decreased after PBMV（P0.05）.PASVI,TASVI were significantly greater and AASVI were significantly lower in patients with MS than the controls（P0.05）.PASVI were increased and AASVI were decreased.TASVI was not significantly different from healthy volunteers after PBMV（P0.05）.LAEFpassive,LAEFactive,LAEF were significantly lower in patients with MS than the controls,and the indices were increased after PBMV（P0.05）.②There were significant correlations between the changes of LA volume and function indices with the changes of MVA and MMG（P0.05）.Conclusion： RT-3DE can evaluate LA function in patients with MS and sinus rhythm before and after PBMV.