超声心动图对房间隔缺损合并肺动脉高压术后的早期评价

Early Evaluation of Echocardiography in Postoperative Patients with Atrial Septal Defect Complicated with Pulmonary Hypertension

目的:应用超声心动图观察房间隔缺损(ASD)合并肺动脉高压(PH)患者行房间隔修补术后的早期疗效,分析超声心动图指标对其评估的应用价值。方法:选择ASD合并PH患者32例,所有患者均行房间隔修补手术。应用超声心动图测量患者术前(术前组)、术后1周内(术后组)的左右室舒张末期内径(LVEDD、RVEDD)、左右室舒张末期左右径(LVEDT、RVEDT),并计算其比值(LVEDT/RVEDT)。测量左房内径(LAD)、左室舒张末期容积(LVEDV)、左室射血分数(LVEF)、肺动脉主干内径(MPAD)、呼气末下腔静脉最大内径(IVC_(max))。应用频谱多普勒测量三尖瓣反流峰值压差(PTr),并计算肺动脉收缩压(PASP)。比较两组间各指标变化,分析手术前后心脏结构、肺动脉压力及血流动力学变化特点。结果:术后组右室结构相关指标:RVEDD、RVEDT较术前组明显减小,LVEDT/RVEDT大于术前组(P<0.01)。两组间左心结构相关指标:LAD、LVEDD、LVEDT、LVEDV差异无统计学意义(P>0.05)。两组间LVEF、MPAD、IVC_(max)差异无统计学意义(P>0.05)。术后组肺动脉压相关指标:PTr、PASP较术前组明显减低(P<0.01)。结论:超声心动图能评估ASD合并PH患者行房间隔修补术后心脏结构及肺动脉压力的早期变化,为临床提供可靠的诊疗依据。

Objective:To observe the early efficacy of atrial septal repair in patients with atrial septal defect(ASD)complicated with pulmonary hypertension(PH)by echocardiography,and to analyze the application value of echocardiography indicators in its evaluation.Methods:32 ASD patients with PH were selected,all patients underwent atrial septal repair surgery.Echocardiography was used to measure the left and right ventricular end-diastolic diameters(LVEDD,RVEDD),and the left and right ventricular end-diastolic transverse diameters(LVEDT,RVEDT)before surgery(preoperative group)and within one week after surgery(postoperative group),and calculated the ratio(LVEDT/RVEDT).Left atrial diameter(LAD),left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),main pulmonary artery diameter(MPAD),and maximum end-expiratory inferior vena cava diameter(IVC_(max))were measured.Tricuspid regurgitation pressure gradient(PTr)was measured by spectral Doppler,and pulmonary systolic pressure(PASP)was calculated.The changes of each index between the two groups were compared,and the characteristics of cardiac structure,pulmonary artery pressure and hemodynamic changes before and after surgery were analyzed.Results:The related indexes of right ventricular structure in the postoperative group:RVEDD and RVEDT were significantly lower than those in the preoperative group,and LVEDT/RVEDT was greater than that in the preoperative group(P<0.01).There was no significant difference in left heart structure related indexes:LAD,LVEDD,LVEDT,and LVEDV between the two groups(P>0.05).There was no significant difference in LVEF,MPAD and IVC_(max) between the two groups(P>0.05).The related indexes of pulmonary artery pressure in the postoperative group:PTr and PASP were significantly lower than those in the preoperative group(P<0.01).Conclusion:Echocardiography can evaluate the early changes of cardiac structure and pulmonary artery pressure in patients with ASD complicated with PH after atrial septal repair,providing a reliable basis for clinical diagnosis and treatment.