Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Assoc...Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.展开更多
Background： To determine the influence of right ventricular function in patients with constrictive pericarditis （CP） undergoing surgery and to compare the outcomes of patients who received surgery with those manage...Background： To determine the influence of right ventricular function in patients with constrictive pericarditis （CP） undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically. Methods： Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded. Results： A total of 58 patients with CP （36 received pericardiectomy, 22 managed medically）, and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically （P = 0.003）, and higher st, rvival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery. Conclusions： Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.展开更多
目的探讨左束支区域起搏与右心室间隔起搏技术对老年患者左心室收缩同步性、心功能的影响。方法回顾性选取2022年2月至2023年3月期间于郴州市第一人民医院心血管内科接受永久性心脏起搏器植入术治疗的80例老年患者的临床资料,根据心脏...目的探讨左束支区域起搏与右心室间隔起搏技术对老年患者左心室收缩同步性、心功能的影响。方法回顾性选取2022年2月至2023年3月期间于郴州市第一人民医院心血管内科接受永久性心脏起搏器植入术治疗的80例老年患者的临床资料,根据心脏起搏电极植入部位分为两组,即对照组、观察组各40例。对照组患者于右心室间隔处植入心脏起搏器,观察组患者于左束支区域植入心脏起搏器。分别于患者心脏起搏器植入术后1个月、术后6个月、术后12个月观察各指标变化,包括左心室收缩同步性参数[左心室收缩期纵向应变达峰时间标准差(time to peak longitudinal strain standard deviation,Tls-SD)、最大差值(time to peak longitudinal strain maximum difference,Tls-dif),左心室收缩期径向应变达峰时间标准差(time to peak radial strain standard deviation,Trs-SD)、最大差值(time to peak radial strain maximum difference,Trs-dif),左心室收缩期环向应变达峰时间标准差(time to peak circumferential strain standard deviation,Tcs-SD)、最大差值(time to peak circumferential strain maximum difference,Tcs-dif)]以及心功能指标[左心室射血分数(left ventricular ejection fraction,LVEF)、心排血量(cardiac output,CO)、心脏指数(cardiac index,CI)]、心腔大小[右心房内径(right atrial inner diameter,RAD)、左心房内径(left atrial diameter,LAD)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)]、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度等。于术后12个月测定起搏参数(感知、阈值、阻抗、心室起搏比例),并统计心脏起搏器植入术后12个月内心力衰竭再入院、死亡等不良事件发生情况。结果术后各时间点观察组心功能指标LVEF、CO、CI略高于对照组,但两组比较差异无统计学意义(P>0.05)。术后各时间点观察组心腔大小指标RAD、LAD、LVEDD、LVESD低于对照组,尤其是术后12个月[RAD:(36.63±2.22)mm vs.(40.13±1.61)mm,LAD:(31.09±1.14)mm vs.(38.32±1.08)mm,LVEDD:(49.76±3.22)mm vs.(54.63±3.14)mm,LVESD:(40.64±2.11)mm vs.(48.11±3.24)mm,P<0.05]。术后各时间点观察组左心室收缩同步性指标LSDI、Tls-SD、Tls-dif、Trs-SD、Trs-dif、Tcs-SD、Tcs-dif均低于对照组,尤其是术后12个月[LSDI:4.86%±0.83%vs.9.49%±0.48%,Tls-SD:(14.42±1.78)ms vs.(25.00±1.43)ms,Tls-dif:(50.92±4.53)ms vs.(90.17±8.41)ms,Trs-SD:(50.37±4.33)ms vs.(69.44±6.52)ms,Trs-dif:(141.03±15.64)ms vs.(179.04±18.42)ms,Tcs-SD:(37.85±3.41)ms vs.(48.10±4.62)ms,Tcs-dif:(130.09±14.53)ms vs.(158.09±18.57)ms,P<0.05]。术后各时间点观察组NT-proBNP浓度略低于对照组,但两组比较差异无统计学意义(P>0.05)。两组起搏程控参数起搏感知、阻抗比较,差异无统计学意义(P<0.05);观察组起搏阈值低于对照组[(0.66±0.10)V vs.(0.75±0.12)V,P<0.05];两组起搏程控参数起搏感知、阻抗、阈值均处于正常范围。观察组心室起搏比例低于对照组(43.23%±4.53%vs.73.43%±6.56%,P<0.05)。术后12个月观察组心力衰竭再入院发生率明显低于对照组,差异有统计学意义(5.00%vs.22.50%,P<0.05)。结论左束支区域起搏技术在改善永久性心脏起搏器植入患者左心室收缩同步性、心功能方面优于右心室间隔起搏技术,术后12个月不良事件发生率较低,更有利于保护心功能,起搏参数稳定,属于一种有效且安全的起搏技术。展开更多
目的探讨多模态超声心动图对肺动脉高压患者右心功能的诊断效能。方法选取2022年1月至2023年8月于金华市中心医院就诊的80例肺动脉高压患者纳入观察组,根据患者的肺动脉收缩压将其分为轻度组[40~50mmHg(1mmHg=0.133kPa),36例]、中度组(5...目的探讨多模态超声心动图对肺动脉高压患者右心功能的诊断效能。方法选取2022年1月至2023年8月于金华市中心医院就诊的80例肺动脉高压患者纳入观察组,根据患者的肺动脉收缩压将其分为轻度组[40~50mmHg(1mmHg=0.133kPa),36例]、中度组(51~70mmHg,20例)和重度组(>70mmHg,24例);选取同期健康体检者80名纳入对照组,所有受试者均进行多模态超声心动图检测,对比其超声检查相关数据,评估多模态超声心动图对肺动脉高压患者右室收缩功能的诊断效能。结果观察组患者的右室舒张末期容积(right ventricular end diastolic volume,RVEDV)、右室收缩末期容积(right ventricular end systolic volume,RVESV)、右室整体无效做功(right ventricular global waste work,RVGWW)均显著高于对照组,右室每搏输出量(right ventricular stroke volume,RVSV)、右室射血分数(right ventrical ejection fraction,RVEF)、三尖瓣环收缩期位移(tricuspid annular plane systolic excusion,TAPSE)、整体纵向应变(global longitudinal strain,GLS)、右室整体做功效率(right ventricular global work efficiency,RVGWE)、右室整体做功指数(right ventricular global work index,RVGWI)、右室整体有效做功(right ventricular global constructive work,RVGCW)均显著低于对照组(P<0.05)。重度组患者的RVEDV、RVESV及RVGWW均显著高于中度组、轻度组,RVSV、RVEF、RVGWE、RVGWI、RVGCW均显著低于中度组、轻度组(P<0.05)。TAPSE、GLS、RVSV、RVEF、RVGWI五项联合诊断肺动脉高压患者右心功能的曲线下面积为0.911,敏感度为92.23%,特异性为96.45%。结论多模态超声心动图能有效评价肺动脉高压患者的右室收缩功能,值得临床推广应用。展开更多
文摘Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.
文摘Background： To determine the influence of right ventricular function in patients with constrictive pericarditis （CP） undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically. Methods： Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded. Results： A total of 58 patients with CP （36 received pericardiectomy, 22 managed medically）, and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically （P = 0.003）, and higher st, rvival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery. Conclusions： Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.
文摘目的探讨左束支区域起搏与右心室间隔起搏技术对老年患者左心室收缩同步性、心功能的影响。方法回顾性选取2022年2月至2023年3月期间于郴州市第一人民医院心血管内科接受永久性心脏起搏器植入术治疗的80例老年患者的临床资料,根据心脏起搏电极植入部位分为两组,即对照组、观察组各40例。对照组患者于右心室间隔处植入心脏起搏器,观察组患者于左束支区域植入心脏起搏器。分别于患者心脏起搏器植入术后1个月、术后6个月、术后12个月观察各指标变化,包括左心室收缩同步性参数[左心室收缩期纵向应变达峰时间标准差(time to peak longitudinal strain standard deviation,Tls-SD)、最大差值(time to peak longitudinal strain maximum difference,Tls-dif),左心室收缩期径向应变达峰时间标准差(time to peak radial strain standard deviation,Trs-SD)、最大差值(time to peak radial strain maximum difference,Trs-dif),左心室收缩期环向应变达峰时间标准差(time to peak circumferential strain standard deviation,Tcs-SD)、最大差值(time to peak circumferential strain maximum difference,Tcs-dif)]以及心功能指标[左心室射血分数(left ventricular ejection fraction,LVEF)、心排血量(cardiac output,CO)、心脏指数(cardiac index,CI)]、心腔大小[右心房内径(right atrial inner diameter,RAD)、左心房内径(left atrial diameter,LAD)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)]、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度等。于术后12个月测定起搏参数(感知、阈值、阻抗、心室起搏比例),并统计心脏起搏器植入术后12个月内心力衰竭再入院、死亡等不良事件发生情况。结果术后各时间点观察组心功能指标LVEF、CO、CI略高于对照组,但两组比较差异无统计学意义(P>0.05)。术后各时间点观察组心腔大小指标RAD、LAD、LVEDD、LVESD低于对照组,尤其是术后12个月[RAD:(36.63±2.22)mm vs.(40.13±1.61)mm,LAD:(31.09±1.14)mm vs.(38.32±1.08)mm,LVEDD:(49.76±3.22)mm vs.(54.63±3.14)mm,LVESD:(40.64±2.11)mm vs.(48.11±3.24)mm,P<0.05]。术后各时间点观察组左心室收缩同步性指标LSDI、Tls-SD、Tls-dif、Trs-SD、Trs-dif、Tcs-SD、Tcs-dif均低于对照组,尤其是术后12个月[LSDI:4.86%±0.83%vs.9.49%±0.48%,Tls-SD:(14.42±1.78)ms vs.(25.00±1.43)ms,Tls-dif:(50.92±4.53)ms vs.(90.17±8.41)ms,Trs-SD:(50.37±4.33)ms vs.(69.44±6.52)ms,Trs-dif:(141.03±15.64)ms vs.(179.04±18.42)ms,Tcs-SD:(37.85±3.41)ms vs.(48.10±4.62)ms,Tcs-dif:(130.09±14.53)ms vs.(158.09±18.57)ms,P<0.05]。术后各时间点观察组NT-proBNP浓度略低于对照组,但两组比较差异无统计学意义(P>0.05)。两组起搏程控参数起搏感知、阻抗比较,差异无统计学意义(P<0.05);观察组起搏阈值低于对照组[(0.66±0.10)V vs.(0.75±0.12)V,P<0.05];两组起搏程控参数起搏感知、阻抗、阈值均处于正常范围。观察组心室起搏比例低于对照组(43.23%±4.53%vs.73.43%±6.56%,P<0.05)。术后12个月观察组心力衰竭再入院发生率明显低于对照组,差异有统计学意义(5.00%vs.22.50%,P<0.05)。结论左束支区域起搏技术在改善永久性心脏起搏器植入患者左心室收缩同步性、心功能方面优于右心室间隔起搏技术,术后12个月不良事件发生率较低,更有利于保护心功能,起搏参数稳定,属于一种有效且安全的起搏技术。
文摘目的探讨多模态超声心动图对肺动脉高压患者右心功能的诊断效能。方法选取2022年1月至2023年8月于金华市中心医院就诊的80例肺动脉高压患者纳入观察组,根据患者的肺动脉收缩压将其分为轻度组[40~50mmHg(1mmHg=0.133kPa),36例]、中度组(51~70mmHg,20例)和重度组(>70mmHg,24例);选取同期健康体检者80名纳入对照组,所有受试者均进行多模态超声心动图检测,对比其超声检查相关数据,评估多模态超声心动图对肺动脉高压患者右室收缩功能的诊断效能。结果观察组患者的右室舒张末期容积(right ventricular end diastolic volume,RVEDV)、右室收缩末期容积(right ventricular end systolic volume,RVESV)、右室整体无效做功(right ventricular global waste work,RVGWW)均显著高于对照组,右室每搏输出量(right ventricular stroke volume,RVSV)、右室射血分数(right ventrical ejection fraction,RVEF)、三尖瓣环收缩期位移(tricuspid annular plane systolic excusion,TAPSE)、整体纵向应变(global longitudinal strain,GLS)、右室整体做功效率(right ventricular global work efficiency,RVGWE)、右室整体做功指数(right ventricular global work index,RVGWI)、右室整体有效做功(right ventricular global constructive work,RVGCW)均显著低于对照组(P<0.05)。重度组患者的RVEDV、RVESV及RVGWW均显著高于中度组、轻度组,RVSV、RVEF、RVGWE、RVGWI、RVGCW均显著低于中度组、轻度组(P<0.05)。TAPSE、GLS、RVSV、RVEF、RVGWI五项联合诊断肺动脉高压患者右心功能的曲线下面积为0.911,敏感度为92.23%,特异性为96.45%。结论多模态超声心动图能有效评价肺动脉高压患者的右室收缩功能,值得临床推广应用。
