实时三维超声心动图评价二尖瓣狭窄经皮球囊扩张术后左右心功能变化

Assessment of function on left atrial and biventricular in patients with rheumatic mitral stenosis before and after percutaneous mitral balloon valvuloplasty by real-time three-dimensional echocardiography

目的探讨应用实时三维超声心动图(RT-3DE)评价风湿性心脏病二尖瓣狭窄(MS)患者经皮球囊扩张术(PMBV)前后心功能变化。方法采集18例MS患者PMBV术前、术后的经胸二维、三维超声心动图图像,应用常规方法及Qlab 10.0软件测量并计算左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房整体射血分数(LAEF)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)、右心室舒张末面积(RVEDA)、右心室收缩末面积(RVESA)、右心室节段面积变化率(RVFAC)、三尖瓣瓣环收缩期位移(TAPSE)、肺动脉收缩压(PAP),应用Tom Tec软件测量并计算右心室舒张末容积(RVEDV)、右心室收缩末容积(RVESV)、右心室射血分数(RVEF),并分析上述测值与二尖瓣口面积(MVA)、平均跨瓣压差(MMG)的相关性。结果 (1)与术前相比,PMBV术后即刻二尖瓣口面积增加,二尖瓣口平均跨瓣压差下降,LAVmax、LAVmin、RVEDV、RVESV、RVEDA、RVESA减小,LAEF、LVEF、RVEF、RVFAC、TAPSE增大,PAP降低,右心室收缩活动增强(P<0.05),而LVEDV、LVESV无统计学差异(P>0.05)。(2)PMBV术后1个月,MS患者各项指标与术前比较仍有统计学意义(P<0.05),而与术后即刻比较,并未见明显统计学差异(P>0.05)。(3)PMBV术前、术后LAVmax、LAVmin、RVEDV、RVESV改变量与MVA改变量呈显著负相关(r值-0.527^-0.376,P<0.05),而与MMG改变量呈显著正相关(r值0.357~0.464,P<0.05);LAEF、RVEF改变量与MVA改变量呈显著正相关(r值0.411~0.472,P<0.05),而与MMG改变量呈显著负相关(r值-0.567^-0.423,P<0.05)。结论 RT-3DE能准确地定量评价PMBV术前、术后左右心功能的变化。

Objective To evaluate left atrial(LA) and biventricular function in patients with rheumatic mitral stenosis(MS) before and after percutaneous mitral balloon valvuloplasty(PMBV) by real-time three-dimensional echocardiography(RT-3DE). Methods Eighteen consecutive patients with severe symptomatic rheumatic MS referred for PMBV were included in the study. In addition to conventional echocardiography to obtain indices including RVEDA, RVESA, RVFAC, TAPSE and PAP, all patients underwent Qlab 10.0 and TomT ec software to assess LA volume indices(LAVmax, LAVmin, LAEF) and biventricular volume indices(LVEDV, LVESV, LVEF, RVEDV, RVESV, RVEF) before and after PMBV. Relationships between the changes of LA and biventricular volume and function indices and the changes of mitral valve area(MVA) and mean mitral gradient(MMG) were analyzed. Results(1) Post-PMBV mean gradient significantly decreased, and the mitral valve area significantly increased compared with Pre-PMBV. LA and right ventricular related indices(LAVmax, LAVmin, RVEDV, RVESV, RVEDA, RVESA, PAP) decreased, and LAEF, LVEF, RVEF, RVFAC, TAPSE increased(P<0.05).(2) LAand biventricular related indices measured 1 month after PMBV had statistically significant difference in patients with MS with Pre-PMBV(P<0.05), but there was no difference between the results obtained from 1 month Post-PMBV and immediately after PMBV(P>0.05).(3)The changes of LA and right ventricular volume indices(LAVmax, LAVmin, RVEDV, RVESV) had significantly negative relationship with the change of MVA(r=-0.527--0.376, P<0.05), while had significantly positive relationship with MMG(r=0.357-0.464, P<0.05). The changes of LA and right ventricular function indices(LAEF, RVEF) had significantly positive relationship with the change of MVA(r=0.411-0.472, P<0.05), while had significantly negative relationship with MMG(r=-0.567--0.423, P<0.05). Conclusion RT-3DE could accurately and quantitatively evaluate heart function in patients with MS before and after PMBV.