超声心动图对移植心脏的动态观察

Dynamic observation of cardiac structural and functional alterations on allografted heart by echocardiography

目的 观察心脏移植患者术后 1年内心脏结构、血流动力学及心包积液的变化。方法 应用超声心动图对 2 3例同种原位心脏移植患者进行术后 1年的随访观察 ,测定各房室腔舒张末内径 (LAD、RAD、LVEDD、RVED) ,室间隔、左室后壁及右室前壁厚度 (IVS、LVPW、RVAW ) ,肺动脉收缩峰压力(PAP) ,二尖瓣口血流频谱E波和A波及其比值 (E、A、E/A)及心包积液厚度 (PE)。结果 心脏移植术后1～ 2周时PAP升高 ,RVED和RAD显著增大 ,随后逐步恢复至正常 ;术后 1～ 2月时IVS、LVPW和RVAW显著增厚 ;术后 1～ 2月时二尖瓣血流频谱E峰明显下降 ,E/A <1;术后 1～ 2周可见中量心包积液 ,1～ 3个月仍有少量心包积液 ,6个月后心包积液消失。结论 同种异体原位心脏移植术后供体心脏结构和功能经历一系列适应性变化 ,这些变化可为心脏移植术后排异反应的判断提供参考。

Objective To observe cardiac structural and functional alterations one year following orthotopic heart transplantation. Methods In 23 patients with orthotopic heart transplantation, the end-diastolic diameter of the atria and the ventricles(LAD, RAD, LVEDD and RVED), the thickness of interventricular septum,left ventricular posterior wall and right ventricular anterior wall(IVS,LVPW and RVAW),and pericardial effusion(PE) were measured by M- and B-mode echocardiography, ventricular early and late diastolic filling peak velocities(E, A and E/A) and systolic peak pulmonary artery pressure(PAP) were assessed by Doppler techniques. Results PAP, RAD and RVED increased at 2 week following heart transplantation and gradually returned normal at one month. At 1-2 month after operation, IVS, LVPW and RVAW increased, and E decreased with a reversed E/A. PE was detected in moderate amount at 1-2 week, in small amount at 1-3 month, and disappeared at 6 month following the transplantation. Conclusions The structures and functions of the transplanted heart undergo serially adaptive changes postoperatively, and evaluation of these alterations echocardiographically may be helpful to identifying allograft rejection.