特发性二尖瓣瓣下左心室室壁瘤的临床特征和超声心动图评价

Clinic features and echocardiographic evaluation of patients with idopathic submitral left ventricular aneurysm

目的探讨特发性二尖瓣瓣下左心室室壁瘤（idopathic submitral left ventricular aneurysm,ISLVA）患者的临床特征，并对其左室整体收缩功能、节段收缩功能及左室舒张功能进行超声心动图评价。方法对8例ISLVA患者的临床特征进行回顾性分析，并对其及20例对照者行常规超声心动图及实时三维超声心动图检查。结果8例ISLVA患者中2例因出现室性心律失常、6例因出现心力衰竭而被诊断，冠状动脉造影无异常，心尖区可闻及收缩期杂音（6例）。4例行二尖瓣手术，1例行室壁瘤切除和射频消融术，1例安装埋藏式心脏复律除颤器，1例仅行药物治疗，死亡1例。ISLVA组的左房、左室舒张末期及左室收缩末期内径均大于对照组（P〈0．05），左室后壁厚度较对照组小（P〈0．05），左室射血分数低于对照组（P〈0．05）；ISLVA组的左室16节段（6个基底段、6个中间段和4个心尖段），左室12节段（6个基底段和6个中间段）和左室6个基底段的达最小收缩容积时间（Tmsv）的标准差（Tmsv 16-SD、Tmsv 12-SD、Tmsv 6-SD）及最大时间差（Tmsv 16-Dif、Tmsv 12-Dif、Tmsv 6-Dif），及其心率校正值均高于对照组（P均〈0．05）。所有ISLVA患者均有不同程度的二尖瓣反流和左室舒张功能减退，5例伴有左房压增高。结论ISLVA患者的临床特征无特异性，超声心动图能全面评价其结构和功能异常。

Objective To study cinical features of patients with idopathic submittal left ventricular aneurysm（ISLVA） and evaluate their global and segmental systolic function as well as diastolic function through echocardiography. Methods Clinical features of eight patients with ISLVA were analysed retrospectively.Standard 2-dimentional and real-time 3-dimentional echocardiography were performed in all the eight cases and other twenty subjects with normal left ventricular（LV） function （defined as control group）.Results Two patients were diagnosed as ISLVA due to ventricular arrythmia and the other six case sowing to congestive heart failure.Coronary angiography was normal in all patients.Apical systolic murmur was audible in 6 cases.Four patients received mitral valve surgical repair,one underwent aneurysm resection and radiofrequency ablation, implantable eardioverter defibrillator was implanted in one case,one was only treated by medication.One case died.Patients with ISLVA demonstrated significanly larger left atrium（LA） and LV diameter （both end-diastolic and end-systolic）, thinner LV posterior wall, and lower LV ejection fraction （LVEF） than controls （ P 〈0.05）.Indexes of the LV 17 segments time-volume curves including the time to minimal systolic volume（Tmsv） 16-SD,Tmsv 12-SD,Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif, Tmsv 6-Dif,Tmsv 16-SD% ,Tmsv 12-SD% ,Tmsv 6-SD% ,Tmsv 16-Dif% ,Tmsy 12-Dif%% ,Tmsv 6-Dif% were significantly higher in patients with ISLVA than those in controls （ all P 〈0.05）. All patients with ISLVA showed mitral regurgitation and decreased LV diastolic function in varying degrees, five patients accompanied by elevated LA pressure.Conclusions Clinical features of patients with ISLVA are nonspecific. Echocardiography can evaluate systematically their functional and structural abnormalities.