超声心动图评价房间隔缺损封堵术后左、右心形态及功能的改变

Echocardiography in evaluation of left, right cardiac morphology and function after transcatheter closure of atrial septal defect

目的 应用经胸超声心动图（TTE）评价房间隔缺损（ASD）封堵术前后左、右心形态及功能的变化.方法 对81例成功施行经导管ASD封堵术的患者进行研究.所有患者均于封堵术前、术后3d、1个月、3个月及6个月进行TTE检查,测量左室舒张末期内径（LVEDD）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）、右室舒张末期前后径（RVEDD）、右房收缩末期长径（RAD1）、右房收缩末期横径（RAD2）、右室舒张末期容积（RVEDV）、右室收缩末期容积（RVESV）、右室射血分数（RVEF）、肺动脉内径（MPAD）及肺动脉收缩压（PASP）；同时测量三尖瓣口舒张早期峰值流速（TVE）、肺动脉瓣口收缩期峰值流速（PSVP）、二尖瓣口舒张早期峰值流速（MVE）、主动脉瓣口收缩期峰值流速（ASVP）并进行统计学分析.结果 ASD封堵术后,3个月内LVEDD、LVEDV、LVESV、LVEF逐渐增大；RVEDD、RAD1、RAD2、RVEDV、RVESV、RVEF逐渐缩小；术后6个月随访时,RVEDD、RVEDV继续缩小,LVEDD、LVEDV继续增大,LVEF、RVEF、RAD1、RAD2无进一步变化；瓣口血流速度在术后3d内变化明显,TVE、PSVP显著减低,MVE、ASVP显著增高,在术后1个月后的随访中逐渐趋于稳定；MPAD、PASP在术后随访中逐渐减低.结论 经皮穿刺ASD封堵术既纠正了心脏解剖畸形,又改善了左、右心的几何形态和功能.TTE可有效地评价ASD封堵术前后心脏形态和功能的改变.

Objective To evaluate the changes in left, right morphology and function after tran- scatheter closure of atrial septal defect （ASD） by transthoracic echoeardiography（Tl＇E）. Methods Eight- y-one patients with ASD underwent echocardiographic examination before and 3 days after transcatheter closure and during 1 month, 3 months and 6 months were followed-up. Left ventricular end-diastolic di- ameter（LVEDD） , left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （ LVESV）, left ventricular ejection fraction（ LVEF）, right ventricular end-diastolic diameter（ RVEDD）, right atrial end-systolic long diameter （RADI）, right atrial end-systolic transverse diameter （RAD2）, right ventricular end-diastolic volume （ RVEDV）, right ventricular end-systolic volume （ RVESV）, right ventricular ejection fraction（ RVEF）, main pulmonary artery diameter（ MPAD）, pulmonary artery systol- ic pressure（PASP）, tricuspid valve early-diastolic E velocity （TVE）, pulmonary valve systolic velocity peak （PSVP）, mitral valve early-diastolic E velocity（ MVE）, aortic valve systolic velocity peak（ASVP） were measured and analyzed. Results LVEDD, LVEDV, LVESV, LVEF were increased, while RVEDD, RAD1, RAD2, RVEDV, RVESV, RVEF were decreased significantly during 3 months follow- up after ASD closure. RVEDD, RVEDV continuously became smaller and LVEDD, LVEDV became lar- ger than those of 3 months, no remarkable difference in LVEF, RVEF, RADI, RAD2 was found between 3 months and 6 months follow-up. The blood flow velocity at valves changed significantly 3 days after op- eration. TVE, PSVP decreased while MVE, ASVP increased. The blood flow parameters appeared to re- main relatively stable one month after operation. MPAD, PASP decreased significantly during 6 months follow-uo. Conclusions Tran^eath^t~r ola f A^r~ 1improve left ventricle and right heart geometry and function. TYE can be used to evaluate the changes of cardiac morphology and function