心脏移植术后非排异期超声心动图表现特点(附1例报告)

目的动态观察原位心脏移植术后1年内不同时间段移植心脏超声心动图表现,研究心脏移植术后非排异期超声心动图表现特点。方法应用Acuson彩色多谱勒超声心动图诊断仪观察房室腔大小、室壁及室间隔厚度、二尖瓣及三尖瓣血流频谱、左室肌质量及肌质量指数,计算不同时间段数值平均值并同术前供体作对照。结果患者在术后1年长期存活,无急性排斥反应发生。超声心动图监测表现为:左室、右室及右房内径显著下降,而左房内径则显著上升;室间隔、左室后壁及右室前壁厚度显著增加;左室肌质量及肌质量指数显著增加;二尖瓣E、A峰及三尖瓣E峰均显著下降,三尖瓣A峰变化不明显。术后4个月出现二尖瓣反流,术后持续存在三尖瓣反流。结论心脏移植术后非排异期的形态、结构及功能具有特殊性,某些特点类似早期急性排斥反应,最终确诊尚需心内膜心肌活检。

Echocardiographical features during the rejection free period after heart transplantation:report of one case

Objective To study the echocardiographic features during the period free of acute allograft rejection after heart transplantation by monitoring one patient within one year after heart transplantation. Methods The dimension of atrial and ventricular, interventricular septal and ventricular wall thickness, blood flow pattern through the mitral and tricuspid valves, left ventricular muscle weight (LVMW) and LVMW index during different periods were measured by echocardiography, and all these data were compared with those of the donor before operation. Results The patient recovered well without any signs of acute rejection. Echocardiography revealed that the dimension of right atrial, left and right ventriculars decreased significantly while left atrial showed significant increase, with obvious increase in the interventricular septal and ventricular wall thickness. LVMW and LVMW index were also significantly increased. The peaks E-and A.wave velocifies of the mitral and tricuspid E peak flow velocity decreased significantly, while the A peak flow velocity of the tricuspid did not undergo any significant changes. Mitral back flow occurred 4 months after the operation and tricuspid back flow persisted after operation. Conclusions The changes of morphology, structure and function of the transplanted heart during periods without rejection are to some extent specific to this special phase, when some of these changes are similar to those during early acute rejection, and correct diagnosis relies on endo-myocardial biopsy.