实时三维超声心动图在鲁登巴赫综合征联合介入治疗中的应用

Application of real-time three-dimensional echocardiography in com- bined interventional therapy of Lutembacher′s syndrome

目的探讨实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)在鲁登巴赫综合征联合介入治疗术前、术中的应用价值。方法对12例确诊鲁登巴赫综合征的患者进行联合介入治疗,在术前应用RT-3DE对房间隔缺损(ASD)及二尖瓣进行观察、测量;术中以RT-3DE指引完成二尖瓣球囊扩张术及ASD封堵术;术前、术后测量的参数有二尖瓣口面积(MVA)、右房左右径(RAD)、肺动脉收缩压(PAPs)、二尖瓣反流量(Mi)。结果通过RT-3DE观察,12例鲁登巴赫患者术后ASD封堵器固定,与术前比较,MVA明显扩大,RAD回缩,PAPs下降[分别为(1.80±0.18)cm2比(1.02±0.16)cm2,(40.32±3.11)mm比(48.33±3.24)mm,(44.06±9.12)mm Hg比(57.57±10.33)mm Hg,均P<0.05,其中1 mm Hg=0.133 kPa];Mi则与术前无明显改变[(3.78±0.59)cm2比(3.53±0.67)cm2,P>0.05]。结论 RT-3DE辅助之下的联合介入术是治疗鲁登巴赫综合征的安全有效的方法 。

Objective To investigate the preoperative and intraoperative clinical value of real-time three-dimensional echocardiography（3DE） in the combined interventional therapy of lutembacher′s syndrome. Methods Combined interventional therapy was performed on 12 patients with Lutembacher′s syndrome. Before the operations, patients′ASD and mitral valve were observed and measured by means of RT-3DE. During the operation, the mitral valve ballon dilation and ASD closure were completed with the guidance of RT-3DE. The preoperative and intraoperative statistics included the mitral valve area（MVA）, right atrium diameter（RAD）, pulmonary arterial systolic pressure（PAPs） and mitral regurgitation（Mi）. Results By observing with RT-3DE, the ASD occluder devices were fixed in the 12 patients with Lutembacher′s syndrome after operations. Compared with the condition before the operations, their MVA enlarged apparently,RAD rebounded, PAPs decended [respectively from（1.80±0.18） cm2to（1.02±0.16） cm2,（40.32±3.11） mm to（48.33±3.24） mm,（44.06±9.12） mm Hg to（57.57±10.33） mm Hg, P 0.05, 1 mm Hg=0.133 kPa]. While Mi did not change obviously [（3.78±0.59） cm2to（3.53±0.67） cm2, P 0.05]. Conclusion With the help of RT-3DE, combined interventional therapy is a safe and effective way to treat Lutembacher′s syndrome.