风湿性心脏病二尖瓣置换术患者右心室功能评价

目的应用实时三维超声心动图（real-time three-dimensional echocardiography，RT-3DE）评价风心病二尖瓣置换术前、后右心室功能的变化。方法通过RT-3DE对85例二尖瓣狭窄伴（或）二尖瓣反流行二尖瓣置换术患者，采集其手术前、后半年右心室全容积图像；将RT-3DE图像导入Tomtec 4D Cardio View工作站，手动调节图像并描记心内膜边界后，软件分析自动得到RVEDV、RVESV、RVEF；手动计算RVSV，分析其手术前后右心室功能相关指标变化情况。结果无论窦性心律（SR）组（39例）还是心房颤动（AF）组（46例），RVEDV、RVESV手术后均较手术前有所减小；RVSV、RVEF有所增大；各测值手术前、后均有明显的统计学差异（P〈0.05）；手术前、后，SR组测值均较AF组大，但两组各测值间，仅RVEF有统计学意义（P〈0.05），相关分析显示：RVEDV手术前后相关性高于RVESV（r=0.784，P＜0.05），提示风心病患者右心功能不全主要与舒张末容积增大有关。结论风湿性心脏病二尖瓣膜置换术后半年时，SR组及AF组患者右心容积均较手术前明显减小，右心功能较前明显改善，SR组较AF组改善明显，这与临床观察一致；二尖辩病变的解除能有效改善患者右心功能。

Function evaluation of rheumatic heart disease and mitral valve replacement surgery in patients with right ventricular

Objective To analyze the anatomy and function of the right ventricle after rheumatic heart disease in patients with mitral valve replacement with RT-3DE quantitative measurement of right ventricular volume （RVV） and right ventricular ejection fraction （RVEF） Methods 85 routine mitral stenosis and （or） mitral regurgitation in patients with rheumatic heart disease were collected preoperatively and after six months of full-volume image of the right ventricle. The right ventricular indicators before and after their surgery were analyzed with 3DE images to Tomtec 4D Cardio View the workstation. Results Sinus rhythm （SR） group and atrial fibrillation （AF） group, RVEDV, RVESV after the operation were reduced compared with before surgery and RVSV, RVEF increased （P~0. 05）. The measured values of the SR group before and after surgery were larger than that of the AF group, but only RVEF was statistically significant （P〈0. 05）. RVEDV before and after surgery were smaller than that of RVESV （r=0.784, P〈0.05）. Conclusion Rheumatic heart disease, mitral valve replacement surgery six months later, right heart volume significantly reduced and right ventricular function improve significantly compared with before surgery. SR group improved significantly than in the AF group, which was similar to the clinical observation. The release of the mitral valve disease can improve right ventricular function.