单心动周期实时三维超声心动图对房间隔缺损患者右心室功能的研究

Evaluation of Right Ventricular Modality and Function in Patients with Atrial Septal Defect by Single Beat Real-time Three Dimensional Echocardiography

目的应用单心动周期实时三维超声心动图(single beat real-time three dimensional echocardiography.s RT-3DE)评价房间隔缺损患者右心室形态及功能,并探讨肺动脉压力对右心室功能的影响.方法研究对象分为4组:房间隔缺损组40例,其中肺动脉压轻度增高者15例(A组),肺动脉压中度增高者15例(B组),肺动脉压重度增高者10例(C组);正常组25例,均行实时三维超声心动图检查,通过右室分析软件获得右室舒张末容积(EDVRV)、右室收缩末容积(ESVRV)、右室每搏量(SVRV)、右室射血分数(RVEF)及右心室容积-时间曲线.结果房间隔缺损组(A、B、C组)EDVRV、ESVRV、SVRV、均大于对照组(P<0.01).C组EDVRV、ESVRV、SVRV大于A、B组(P<0.01).A、B组RVEF与对照组相比无明显差异(P>0.05),而C组的RVEF小于对照组及A、B组(P<0.01).C组RVEF与EDVRV、ESVRV、SVRV呈负相关(R=-0.738,P<0.05).房间隔缺损组右室容积随时间变化幅度较对照组低.结论 RT-3DE可快速、无创、准确的测定房间隔缺损患者右心室容积及射血分数,能反映其形态及功能的改变.随着肺动脉压力的升高,右心室容积代偿性增大,RVEF无明显降低,当肺动脉压重度增高时,右心功能失代偿,RVEF明显下降.右室容积及右心功能的变化可以间接反映肺动脉压力的高低.

Objective To evaluate the modality and function of right ventricular in patients with atrial septal defect by single beat real-time three dimensional echocardiography.s RT-3DE）, and discuss how the pulmonary artery pressure affect the function of right ventricular.Methods The enrolled subjects were divided into four groups,twenty-five healthy volunteers and forty ASD patients were enrolled consecutively as normal controls and the ASD group respectively.The ASD group was divided into three groups, fifteen with pulmonary artery pressure mildly rised as group A, and fifteen with pulmonary artery pressure moderately rised as group B, fifteen with pulmonary artery pressure highly rised as group C. Single cardiac cycle real-time three dimensional echocardiography was performed in all to evaluate parameters concerning modality and systolic function of participants right ventricle.Full-volume imaging was performed and the data was analyzed by right ventricular analysis（RVA） software. The end diastolic volume（EDVRV）, end systolic volume（ESVRV）, stroke volume（SVRV） and ventricular ejection fraction（RVEF） of right ventricular were obtained, as well as the volume-time curve.Results EDVRV, ESVRV and SVRV of atrial septal defects group（group A,B,C） were greater than the control group（P 〈0.01）. EDVRV,ESVRV and SVRV of group C were greater than group A and B（P 〈0.01）. Compared with A and B group, the RVEF of control group has no significant difference.（P 〉0.05）, whereas RVEF of group C was less than the control group,group A and B（P〈 0.01）. RVEF and EDVRV,ESVRV,SVRV showed a negative correlation in Group C（R =-0.738,P 〈0.05）. The right ventricular volume change over time of atrial septal defects was lower than those of control group.Conclusions The s RT-3DE has an obvious advantage than normal test in evaluating the change of the right ventricular function and shapes without wound.With the increase of pulmonary artery pressure,the volume of right ventricular in patients with atrial septal defects increase but RVEF does not decrease, when the pulmonary artery pressure highly increased, the function of right ventricular decompensated,RVEF decreased obviously.The changes of volume and function of right ventricular can indirectly reflect the pulmonary artery pressure.