重度左心室扩大患者术后早期心脏形态学变化及其意义

目的　探讨重度左心室扩大患者术后形态学变化与左心室收缩功能及预后的关系。　方法　对 16例重度左心室扩大患者术前、术后早期 (7～ 10d)进行彩色多普勒心脏超声检查 ,结合临床表现进行分析。　结果　扩大的左心室术后明显缩小 ,左室舒张末径指数 (LVEDDI)术前为 (4 4 10± 5 2 4)mm/m2 ,术后为 (36 0 1± 9 5 3)mm/m2 (P <0 0 1) ,术后左室收缩功能暂时下降。左室射血分数 (EF)术前为 (4 8 0 0± 11 71) % ,术后为 (4 0 15± 8 6 9) % (P <0 0 1) ;左室缩短分数 (FS)术前为 (2 2 82± 6 2 7) % ,术后为 (19 6 3± 3 42 ) % (P >0 0 5 )。术后心律失常发生率为 75 %。 2例 (12 5 % )术后扩大左心室不回缩的患者有严重低心排 ,其中 1例 (6 2 5 % )死亡。　结论　重度扩大的左心室手术后早期即回缩 ,如不回缩 ,预后不佳。术后左心室缩小 ,心功能并不随之立即改善 ,反而较术前暂时下降 ,心律失常发生率高。

Reversal of severe left ventricular dilatation after operation and its correlation with cardiac function

OBJECTIVE: To investigate the relationship between the reversal of left ventricular dilatation and postoperative cardiac function, and prognosis. METHODS: 16 patients with severely dilated left ventricle underwent echocardiographic examinations preoperatively and at discharge (7 - 10 days after operation). Left ventricular (LV) diameters were measured (LVEDD, LVESD) and matched to body surface area (LVEDDI, LVESDI) and fractional shortening (FS); left ventricular ejection fraction (EF) was calculated. RESULTS: Left ventricular dimensions significantly decreased at discharge after operation. Preoperative LVEDD was (78.54 +/- 6.30) mm and postoperative LVEDD (63.77 +/- 13.69) mm (P < 0.01). Preoperative LVESD (60.03 +/- 8.95) mm and postoperative LVESD (53.23 +/- 12.68) mm (P < 0.05). Preoperative LVEDDI was (44.10 +/- 5.24) mm/m(2) and postoperative LVEDDI (36.01 +/- 9.53) mm/m(2) (P < 0.01). Preoperative LVESDI was (34.78 +/- 6.22) mm/m(2) and postoperative LVESDI (30.90 +/- 9.19) mm/m(2) (P < 0.05). Left atrium (LA) dimension was shorter after operation than before operation. Left ventricular construction didn't improve postoperatively, even temporarily decreased at discharge. Preoperative EF was (48.00 +/- 11.71)% and postoperative EF (40.15 +/- 8.69)% (P < 0.01). Preoperative FS was (22.82 +/- 6.27)% and postoperative FS (19.63 +/- 3.42) (P > 0.05). The incidence of postoperative cardiac arrhythmia was 75%. No dimension changes were observed in 2 patients with severely dilated left ventricles after operation: one (LVEDDI 56 mm/m(2)) died, and the other had severe low cardiac output. Six of 14 who had reduced dilated left ventricle didn't reach normal limits, still in the range of severe dilated left ventricule (LVEDDI > 37 mm/m(2)). CONCLUSIONS: Most patients decreased the dimension of left ventricular size early after operation, but some had partial recovery from severe ventricular dilatation. Although left ventricular dimensions (LVEDD, LVESD, LVEDDI, LVESDI) significantly reduced, cardiac function didn't improve at once with the reversal of left ventricular dilatation, but temporarily decreased after operation and the incidence of cardiac arrhythmia was high.