风湿性二尖瓣狭窄患者左心房流体力学观察

Observation of left atrial hydrodynamic change in patients with rheumatic mitral stenosis

目的 探讨风湿性二尖瓣狭窄 (MS)患者发生心房颤动 (AF)与左心房流体力学环境的关系。 方法 根据术前心律情况不同 ,将 4 9例合并 AF的 MS患者分为 2组 ,A组 (n=2 5 ) :合并慢性 AF,B组 (n=2 4 ) :均为窦性心律 ;对照组 :2 9例正常人作为对照。采用超声心动图检测 3组左心房流体力学指标 ,术后 6～ 8个月复查。 结果 术后 A组左心房机械应力 (L AS)、左心房面积 (L AA)和左心房容积 (L AV)均较术前降低或减少 ,B组 L AS亦较术前明显降低 (P<0 .0 1)。术前 A组 L AS明显低于 B组 ,L AA、L AV明显大于 B组 ;术后 A组 L AA、L AV仍大于 B组 (P<0 .0 1)。术前、术后 A组、B组 L AS、L AA、L AV均高于或大于对照组。 结论 MS患者术后左心房流体力学环境远未恢复正常 ,L AS可能是导致 MS患者发生 AF的重要因素。

Objective To investigate the correlation between the left atrial hydrodynamic change and atrial fibrillation (AF) in the patients with rheumatic mitral stenosis. Methods According to cardiac rhythm before operation, 49 patients with rheumatic mitral stenosis accompanying chronic AF were divided into two groups,group A: AF, 25 cases; group B: sinus rhythm, 24 cases. Control group : 29 healthy volunteers were examined. By using echocardiography, left atrial hydrodynamics were tested, and repeated 6-8 months after the operation. Results Left atrial stress (LAS), left atriala area (LAA) and left atrial volume(LAV) in group A after operation was much lower than before operation, LAS after operation in group B was also lower than before operation(P<0.01). Before operation, LAS in group A was significantly lower than that in group B, LAA and LAVwere larger. After operation, LAA and LAV in group A were significantly larger than those in group B(P<0.01). LAS, LAA and LAV in group A and group B before and after operation were higher than those in control group. Conclusion Left atrial hydrodynamic enviroment in patients with mitral stenosis has not reached normal even after valve replacement, LAS may be an important factor of causing AF.