二尖瓣狭窄患者瓣膜置换术后血流动力学改变的超声评价

Evaluation of hemodynamics in patients with mitral stenosis after mitral valve replacement by echocardiography

目的:观察单纯二尖瓣狭窄患者瓣膜置换术前后心脏结构、功能以及血流动力学的改变,为临床决策以及新型瓣膜开发提供参考信息。方法:将2012年12月至2015年12月在华西医院、湘雅三医院行单纯二尖瓣机械瓣置换术患者且在1年后进行超声心动图随访的58例患者纳入研究。采用左心房径(LA)、左心室径(LV)、右心房径(RA)、右心室径(RV)、左心室射血分数(LVEF)、左心室缩短分数(LVFS)、二尖瓣有效瓣口面积(EOAmv)、二尖瓣E峰血流速度(Emv)、左心房面积(LAA)、左心房容积(LAV)、二尖瓣平均跨瓣压差(MPGmv)、二尖瓣速度时间积分(VTImv)、二尖瓣压力降半时间(PHTmv)等指标评估心脏结构、功能及血流动力学改变。结果:LA、LAA及LAV显著低于术前测值(P<0.05),LV、RA及RV手术前后比较差异无统计学意义。反映左心功能的指标,手术前后性差异无统计学意义。EOAmv在术后明显改善,MPGmv、VTImv、PHTmv均较术前明显减小(P<0.05)。结论:与术前相比,单纯二尖瓣狭窄患者术后大多数血流动力学指标均得到明显改善。

Objective： To investigate echocardiography parameters of patients with mitral stenosis after mitral valve replacement and to provide valuable informations for clinical management and the development of novel valve. Methods： A total of 58 patients who underwent mitral valve replacement from December 2012 to December 2015 were enrolled in this study. They had been followed up with echocardiography 1 year after operation. Left atrial diameter（ LA）,left ventricular diameter（ LV）,right atrial diameter（ RA）,right ventricular diameter（ RV）,left ventricular ejection fraction（ LVEF）,left ventricular fractional shortening（ LVFS）,mitral effective orifice area（ EOAmv）,peak E velocity of mitral valve（ Emv）,left atrial area（ LAA）,left atrial volume（ LAV）,mitral mean pressure gradient（ MPGmv）,velocity time integral（ VTImv） and pressure half time（ PHTmv） had been investigated to evaluate the changes of cardiac structure,function and hemodynamics. Results： Compared with preoperative results,LA,LAA and LAV were significantly lawer then those before operation（ P〈0. 05）,but there was no significant difference in LV,RA,RV before and after operation. There was no significant difference in the index of left ventricular function before and after operation. Mitral effective orifice area（ EOAmv） was significantly increased,while MPGmv,VTImv and PHTmv were significantly decreased（ P〈0. 05）. Conclusion： Hemodynamic parameters have been significantly improvedafter mitral valve replacement.