实时三维超声心动图对法洛四联症手术前后右室收缩功能分析

目的 应用实时三维超声心动图(RT-3DE)检测法洛四联症(TOF)手术前后右室收缩功能.方法 30例TOF患者常规二维超声心动图检查并确诊后,使用RT-3DE采集患者的右室全容积数据库,分析右室舒张末容量(RVEDV)、收缩末容量(RVESV),计算射血分数(EF).比较术前、术后12 d、术后3个月RVEDV、RVESV及EF值的变化.结果 30例患者中20%(6/30)患者术前右室EF低于50%,术后12 d收缩末容量较术前增加(P<0.05),EF值较术前减低(P<0.05),术后3个月RVEDV较术前增大(P<0.05).常规二维超声术后复查,70%患者(21/30)残留肺动脉分支狭窄,所有患者均存在肺动脉瓣反流.结论 RT-3DE能简便、准确地确定右室容积并计算右室收缩功能;TOF患者术后残留肺动脉分支狭窄及肺动脉瓣反流可能导致右室收缩功能下降.

Evaluation of right ventricular systolic function pre- and post- operation in patients with tetralogy of Fallot by real time three dimensional echocardiography

Objective To evaluate right ventricular systolic function pre-and post-operation in patients with tetralogy of Fallot by real time three dimensional echocardiography (RT-3DE) , and to determine its clinical value. Methods Thirty patient with tetralogy of Fallot confirmed by two dimensional echocardiography (2DE), right ventricular "full volume" imaging was acquired by RT-3DE. Right ventricular end diastolic volume (RVEDV) and end systolic volume (RVESV) were outlined by the analysis software of RT-3DE; RV ejection fraction (EF) was calculated. RVEDV, RVESV, RVEF were compared pre-operation, 12 d and 3 months after operation. Results RVEF was lower than 50% in 30% patients with TOF pre-operation. Post-operation RVESV, RVESV increased while RVEF decreased compared with pre-operation. Pulmonary branch stenosis still existed in 21 patients after operation with 2DE; Pulmonary regurgitation existed in all patients. Conclusion Real time three dimensional echocardiography could be used as a accurately, noninvasively method to determine right ventricular volume and function of TOF patients. After operation RV function in patients with TOF decreases compared with that before operation and pulmonary branch stenosis and pulmonary regurgitation may be part of the reasons.