超声心动图评价左室部分切除成形术的血流动力学变化

Hemodynamics Evaluation by Echocardiography after Partial Left Ventriculectomy

目的 应用超声心动图评价左心室部分切除成形术治疗终末期扩张型心肌病血流动力学变化。方法 自 1998年 4月至 12月 ,12例经末期扩张型心肌病患者接受了左心室部分切除术治疗。术前及术后 1个月内行经胸超声心动图 ,术中行经食管超声心动图检查 ,取左室长轴切面测量左室内径 ,以双面面积长轴法测量左室收缩功能 ,用 9段记分法定量评价室壁运动。结果 左室心肌平均切除重量 44 8± 12 5g。超声心动图检查 :左室舒张末期、收缩末期内径显著减少 (81 5± 11 5 3至 6 5 9± 10 2 9mm) ;(72 6 7± 11 2 8至 5 8 16± 10 2 7mm) ,P <0 0 5。左心射血分数增加 (19 4%± 7 4%至 2 9 73 %± 8 17% ) ,P <0 0 1;每搏量和左室整体及局部室壁运动得分无明显改变 ,P >0 0 5。结论 左室部分切除治疗晚期扩张型心肌病近期能显著减少心腔内径、心室容积 ,每搏量无增加 ,室壁运动幅度无明显改变 ,远期效果并不象人们所期盼的那样 ,心功能改善不明显。射血分数的提高可能仅仅依赖于舒张末期容积的减低和二尖瓣返流的矫正。

Purpose We report the effectness of partial left ventriculectomy (PLV) in hemodynamics by ECHO for end-stage heart failure due to idiopathic dilated cardiomyopathy(IDCM). Methods 12 patients with IDCM received PLV at Anzhen hospital,from April to December 1998.Left ventricular (LV) function was assessed by two\|dimensional echocardiography with biplane area-lengh axis method and M-mode.Quantitative evaluation of the LV wall motion with a score method of 9 segment of left ventricular.annuloplastys were undergone in all patients and tricuspid annuloplasty in 6 of them. Results The average weight of the resected left ventricle was 44.8±12.5 g.Echocardiography demonstrated a significant decrease in the left ventricular diastolic and systolic diameter respectively (from 81.54±11.53 to 65.9±10.29 mm),(from 72.67±11.28 to 58.16±10.27 mm), P <0.05.And increase of LV ejection fraction (EF) (from 19 4±7 8% to 29 8±8 9%) P <0 01.But no changed in stroke volume (SV) and score of LV regional and global wall motion at postoperation. Conclusion PLV operation is a new method for the surgical treatment of end-stage IDCM and decreases LV size and volume and increases LVEF,without increasing SV at the early result,but the long-term outcome was suboptimal change in LV function. [