超声心动图评价二叶式AVR术后心脏结构与功能变化

目的应用超声心动图评估主动脉瓣病变患者在主动脉人工瓣置换术(AVR)术后心脏结构与功能变化。方法选取AVR术后患者77例,根据术前诊断分为3组,AI组(单纯主动脉辯关闭不全)27例,AS组(单纯主动脉瓣狭窄)20例,BAV组(二叶式主动脉瓣膜病)30例,同时选取健康体检者25例作为对照组。超声随访AVR患者4年,采集患者的主动脉窦部内径(Ao-s)、升主动脉内径(Ao-asc),左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs),室间隔舒张期厚度(Ivsd),左室后壁舒张期厚度(LVPWd)、左室射血分数(LVEF)、左室短轴缩短率(FS)并进行对比分析。结果与对照组比较,手术前BAV组和AI组患者的Ao-s、Ao-asc、LVDd、LVDs、IVSd、LVPWd均升高,LVEF、FS均降低;AS组患者的Ao-asc、LVDd、IVSd、LVPWd均升高。术后3个月,BAV组患者的LVDd、LVDs均降低,AI组患者的Ao-s、LVDd、LVDs均降低。BAV患者在4年的随访中Ao-s、Ao-asc有扩张趋势,术后4年与术后3个月比较,Ao-s、Ao-asc增宽;AS、AI患者在4年的随访中,Ao-s、Ao-asc变化无明显差异。结论AVR能够有效阻止BAV患者的心室重构,但术后依然有发生升主动脉扩张的概率,因此应定期进行超声心动图随访关注心脏及大血管变化。

Objective To evaluate the changes of cardiac structure and function in patients of aortic valve after aortic valve replacement.Methods 77 patients with aortic valve replacement were divided into 3 groups,AI group had 27 cases,AS group had 20 cases,BAV group had 30 cases,and 25 healthy subjects were selected as the control group.AVR patients were followed up by ultrasonography for 4 years,and the basic parameters were collected and analyzed such as aortic sinus diameter,ascending aorta diameter,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,Interventricular septum thickness,left ventricular posterior wall diastolic thickness,left ventricular ejection fraction,and left ventricular fraction shortening rate.Results Compared with the control group before surgery,Ao-s,Ao-asc,LVDd,LVDs,IVSd,and LVPWd in patients of the BAV group and the AI group were all higher,and LVEF and FS were lower;Ao-asc,LVDd,IVSd,and LVPWd in patients of AS group were higher.The LVDd and LVDs of patients in BAV group were decreased after 3 months surgery;the Ao-s,LVDd and LVDs of patients in AI group were decreased.Ao-s and Ao-asc had a tendency to increase during the 4-year follow-up of BAV patients,compared with 4 years and 3 months after surgery,Ao-s,Ao-asc were increased.During the 4-year follow-up of AS and AI patients,there were no significant differences in Ao-s and Ao-asc.Conclusion AVR can effectively prevent ventricular remodeling in patients of BAV,but there is still a possibility of ascending aortic dilatation after surgery.Therefore,regular echocardiographic follow-up should be performed to pay attention to changes in the heart and large blood vessels.