组织多普勒成像评价室间隔缺损合并肺动脉高压手术前后右室功能的研究

ASSESSMENT OF RIGHT VENTRICULAR FUNCTION OF VENTRICULAR SEPTAL DEFECT WITH PULMONARY HYPERTENSION BEFORE AND AFTER OPERATION BY TISSUE DOPPLER IMAGING

目的探讨应用组织多普勒成像定量评价室间隔缺损合并肺动脉高压手术前后右室功能的临床价值。方法 56例VSD患者分为PH(+)组(n=33)和PH(-)组(n=23)。应用组织多普勒成像技术于手术前及手术后1个月、6个月分别测量两组的三尖瓣环Sa、Ea与Aa、右室IVCT、IVRT、ET、Tei指数。结果两组手术后1个月及6个月的左室舒张末期内径、左房内径及肺动脉收缩压均小于术前,差异有统计学意义(p<0.05)。在PH(-)组,术后6个月肺动脉收缩压低于术后1个月,差异有统计学意义(p<0.05),术后6个月三尖瓣环Sa高于术前,差异有统计学意义(p<0.05)。在PH(+)组,术后6个月的IVRT、Tei小于术前,术后6个月的ET大于术前,差异有统计学意义(p<0.05)。结论组织多普勒成像技术能定量评价室间隔缺损合并肺动脉高压患者手术前后右室功能的变化,判定肺动脉高压对预后的影响。

Objective To evaluate the right ventricular function of ventricular septal defect（VSD） with pulmonary hypertension before and after operation by tissue Doppler imaging（TDI） Methods The study included 56 patients with VSD were divided into two groups according to the baseline systolic pulmonary artery pressure（PAP≥40 mmHg,n = 33;PAP 40 mmHg,n = 23）,Right ventricular function was assessed by Two-dimensional echocardiography and TDI examination in two groups before operation.Assessments were repeated one month and six months after VSD repair.Peak systolic（S）,early diastolic（E） and late diastolic（A） maximum velocities,isovolumic contraction time（IVCT）,ejection time（ET）,isovolumic relaxation time（IVRT） were measured by TDI from the sites of tricuspid annulus.Then Tei index were calculated.Results Left ventricular end-diastolic dimension（LVEDd）,Left atrial diameter and systolic pulmonary artery pressure were lower than the baseline in two groups（p 0.05）.systolic pulmonary artery pressure was significant decrease from one month after operation at six months（p 0.05）,and peak systolic（S） was increase from baseline at six months in patients without PH（p 0.05）.six-months IVRT values and Tei index of group PH（＋） were lower than baseline（p 0.05）.However,ET was higher than those of patients in group PH（＋）（p 0.05）.Conclusion TDI can be used to quantitative estimate the right ventricular function comprehensively and exactly in patients with pulmonary hypertension after VSD repair,and to evaluate the effect of pulmonary hypertension on right ventricular function.