二尖瓣狭窄患者瓣膜置换术后血流动力学改变的超声评价

目的:观察单纯二尖瓣狭窄患者瓣膜置换术前后心脏结构、功能以及血流动力学的改变,为临床决策以及新型瓣膜开发提供参考信息。方法:将2012年12月至2015年12月在华西医院、湘雅三医院行单纯二尖瓣机械瓣置换术患者且在1年后进行超声心动图随访的58例患者纳入研究。采用左心房径(LA)、左心室径(LV)、右心房径(RA)、右心室径(RV)、左心室射血分数(LVEF)、左心室缩短分数(LVFS)、二尖瓣有效瓣口面积(EOAmv)、二尖瓣E峰血流速度(Emv)、左心房面积(LAA)、左心房容积(LAV)、二尖瓣平均跨瓣压差(MPGmv)、二尖瓣速度时间积分(VTImv)、二尖瓣压力降半时间(PHTmv)等指标评估心脏结构、功能及血流动力学改变。结果:LA、LAA及LAV显著低于术前测值(P<0.05),LV、RA及RV手术前后比较差异无统计学意义。反映左心功能的指标,手术前后性差异无统计学意义。EOAmv在术后明显改善,MPGmv、VTImv、PHTmv均较术前明显减小(P<0.05)。结论:与术前相比,单纯二尖瓣狭窄患者术后大多数血流动力学指标均得到明显改善。

Evaluation of hemodynamics in patients with mitral stenosis after mitral valve replacement by echocardiography

Objective:To investigate echocardiography parameters of patients with mitral stenosis after mitral valve replacement and to provide valuable informations for clinical management and the development of novel valve.Methods:A total of 58 patients who underwent mitral valve replacement from December 2012 to December 2015 were enrolled in this study.They had been followed up with echocardiography 1 year after operation.Left atrial diameter(LA),left ventricular diameter(LV),right atrial diameter(RA),right ven-tricular diameter(RV),left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),mitral effective orifice ar-ea(EOAmv),peak E velocity of mitral valve(Emv),left atrial area(LAA),left atrial volume(LAV),mitral mean pressure gradient (MPGmv),velocity time integral(VTImv) and pressure half time(PHTmv)had been investigated to evaluate the changes of cardiac structure,function and hemodynamics.Results:Compared with preoperative results,LA,LAA and LAV were significantly lawer then those before operation(P<0.05),but there was no significant difference in LV,RA,RV before and after operation.There was no signif-icant difference in the index of left ventricular function before and after operation.Mitral effective orifice area(EOAmv) was significant-ly increased,while MPGmv,VTImv and PHTmv were significantly decreased (P<0.05).Conclusion:Hemodynamic parameters have been significantly improvedafter mitral valve replacement.