定量组织速度成像技术评价风湿性心脏病患者射频消融改良迷宫手术前后的心功能

Evaluation of heart function in patients with rheumatic heart disease before and after modified MAZE procedure using irrigated radiofrequency operation by quantitative tissue velocity imaging

目的探讨定量组织速度成像(quantitative tissue velocity imaging,QTVI)对风湿性心脏病合并房颤患者换瓣联合射频消融改良迷宫手术前后心脏功能的评价作用。方法 56例风湿性心脏病合并房颤患者,其中25例行换瓣联合射频消融改良迷宫手术,31例仅行换瓣手术,对术前、术后1、3个月的心脏运动情况进行测量并比较分析。结果本组患者术前心脏运动紊乱,房、室运动失去协调;舒张、收缩运动衔接差;室壁及室间隔的节段性运动失去规律。术后迷宫手术组心脏运动房室运动协调性、室壁收缩节段性等明显恢复,单纯换瓣组改善不明显。术后1个月迷宫手术组患者左室EF较术前进一步降低[(42.6±13.5)%vs.(46.8±13.2)%,P<0.05],单纯换瓣组较术前差异无统计学意义。术后3个月迷宫手术组EF升高[(53.2±15.1)%vs.(42.6±13.5)%,P<0.05],二尖瓣下移距离增大[(9.9±1.7)mm vs.(8.1±2.7)mm,P<0.05]、三尖瓣环下移距离增大[(10.5±0.9)mm vs.(8.8±2.8)mm,P<0.05];单纯换瓣组左室EF、瓣环平均下移距离均无明显变化。结论迷宫手术对心功能恢复有益,但在术后早期心功能仍较差,左心功能仍维持低水平,需要继续药物治疗,且有必要做更长时间的随访复查,以便指导患者术后的恢复治疗。

Objective To evaluate the heart function in patients with rheumatic heart disease before and after modified MAZE procedure using irrigated radiofrequency operation by quantitative tissue velocity imaging（QTVI）.Methods Fifty-six patients with rheumatic heart disease and atrial fibrillation（group 1：25 patients with valve replacement and MAZE operation;group 2：31 patients with only valve replacement）.The parameters of heart movement were measured by QTVI.The patients were measured at preoperative period,1 month and 3 months postoperative respectively.Results ① The preoperative movements of heart are turbulence.The order of heart movement recovers partially after MAZE operation.②LVEF were lower than that before operation in group one but not in group two.③LVEF had no change in group two,but increased in group one.The SD of mitral and tricuspid annuli began to increase at the 3rd month after operation in group one but not in group two.Conclusion MAZE operation is beneficial to the recovery of heart function.But drug therapy is still needed shortly after operation,when the injured myocardium has not recovered completely.