二维应变显像评价房间隔缺损封堵术后妊娠母体的右心功能

Evaluation of right heart function by two-dimensional strain imaging in pregnant women after transcatheter closure of atrial septal defect

目的应用二维应变显像技术定量评价房间隔缺损封堵术后孕妇妊娠期的右心功能状态。方法选择孕前行房间隔封堵术的孕妇25例(观察组),选择同期年龄、身高、体质量相匹配的正常孕妇25例(对照组)。应用二维应变显像技术分别测量2组右心室游离壁基底段和中间段收缩期峰值应变(strain of systole,S)、舒张早期峰值应变率(strain rate of early diastolic,SRe)、舒张晚期峰值应变率(strain rate of atrial systole,SRa)、舒张期应变率比值;常规测量右心室横径、右心房横径、右心室舒张期末容积、右心室收缩期末容积、右心室射血分数以及三尖瓣反流速度估测肺动脉收缩压。结果 2组右心室横径、右心室收缩压随时间的延长逐渐增加,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组SRe/SRa基底段、SRe/SRa中间段随时间的延长逐渐降低,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。结论房间隔缺损封堵术后妊娠母体右心功能部分指标出现有意义的变化,二维应变成像技术可以定量评价其右心功能状态。成年期后行房间隔封堵术同时房间隔缺损偏大的女性,在进入妊娠期要关注肺动脉压力进展及右心功能指标变化。

Objective To investigate of right heart function by two-dimensional strain imaging in pregnant women after transcatheter closure of atrial septal defect.Methods Using two-dimensional strain imaging,the right ventricular free wall base, middle sections of longitudinal peak systolicvelocities(strain of systole,S),early diastolic peak strain rate(strain rate of early diastolic,SRe),late diastolic peak strain rate(strain rate of atrial systole,SRa),SRe/SRa were calculated repeatedly in 25 pregnant women after transcatheter closure(PASD group),and25 healthy pregnant women as controls(control group).Diameter of the right atrium and right ventricular,pulmonary artery systolic pressure estimated by tricuspid regurgitation velocity,right ventricular end-diastolic volume,right ventricular end-systolic volume,right vertricular ejection fraction were calculated.Results Inner diameter of the right ventricular and pulmonary artery systolic pressure of two groups increased gradually over time.There were significant difference between the two groups,between time point,and between group &time point(P<0.05).SRe/SRa of base,middle sections in PASD group and control group showed decreasingly trend with the increase in pregnancy,and there were significant difference between the two groups,between time point,and between group & time point(P<0.05).Conclusion The parameters of right heart function in pregnant women after transcatheter closure of atrial septal defect had showed some significant change,especially by two-dimensional strain imaging.The pregnant women which have the history transcatheter closure of atrial septal defect need to focus on their PASP and parameters of right heart function in duration of pregnancy.