组织多普勒对"缘对缘"二尖瓣成形术后左心室舒张功能评价

目的:EMVP技术将脱垂的二尖瓣叶相对应的前后叶缝合起来,形成一个双孔二尖瓣,从而改变了二尖瓣的解剖形态,本文旨在研究组织多普勒在"缘对缘"二尖瓣成形术后左心室舒张功能的作用.方法:30例二尖瓣关闭不全患者根据成形方式被分成A、B组,A组:15例二尖瓣后叶脱垂患者接受后叶楔形切除;B组:15例前叶或双叶脱垂患者接受"缘对缘"二尖瓣成形术,所有患者均同时接受二尖瓣环成形.术前及术后1周,运用彩色多普勒、组织多普勒测定患者左心室舒张功能指标,包括:术前和术后E峰与A峰血流速比值(E/A),舒张期E峰血流速度与舒张早期二尖瓣环的最大运动速度的比值(E/Em), 舒张早期二尖瓣环的最大运动速度与舒张晚期二尖瓣环的最大运动速度的比值(Em/Am).结果:A组与B组成形术后二尖瓣口面积及二尖瓣反流程度均明显减小,E/A、E/Em及Em/Am在手术前后组间及组内之间均无明显变化.结论:组织多普勒能较好客观地评价"缘对缘"二尖瓣成形后左心室舒张功能,"缘对缘"二尖瓣成形技术效果良好,对左心室的舒张功能无明显影响.

The evaluation of tissue Doppler imaging for left ventricular diastolic function after edge-to-edge mitral valve plasty

Objective:Edge-to-edge mitral valve plasty technique anchors the correspondence leaflet to create a double-orifice mitral valve, and it absolutely changes the original mitral valve anatomy.This study was aimed to assess tissue Doppler imaging for left ventricular diastolic function after edge-to-edge mitral valve plasty. Method:Thirty patients with mitral regurgitation were included and divided into 2 groups. Quadrangular resection was operated on fifteen cases with posterior proplapse in group A, and Edge-to-edge mitral valve plasty was underwent on fifteen cases with anterior or bileaflet proplapse in group B. To evaluated the left ventricular diastolic function. The ratio pf the peak E velocity and A velocity(E/A), the ratio of the early diastolic peak flow velocity to the early diastolic mitral valve annular movement velocity(E/Em), and the ratio of early diastolic mitral valve annular movement velocity to late diastolic mitral valve annular movement velocity(Em/Am)were measured before operation and 1 week after operation respectively.Result:The mitral valve area and the mitral regurgitant grade were decreased dramatically after operation in both groups. The evaluations of E/A, E/Em, and Em/Am were no significant difference between two groups and in each group before and after operation. Conclusion:Tissue Doppler imaging is a good way to evaluate left ventricular diastolic function after edge-to-edge mitral valve plasty, and this procedure has no significant influence on left ventricular diastolic function with satisfactory results.