三尖瓣环成形术后右心室收缩功能超声评价指标的探讨

目的：研究三尖瓣环的收缩期位移（tricuspid annular plane systolic excursion,TAPSE）和收缩期峰值运动速度（tricuspid annular peak systolic velocity,TAPSV）指标能否准确评估三尖瓣环成形术（tricuspid valve plasty,TVP）后的右心室收缩功能.方法：选择左心瓣膜手术同时行TVP的患者45例.术前和术后测量右心室面积变化率（RVAC）、TAPSE及TAPSV等多项指标.术前、术后1w、术后3、6及12个月各复查经胸超声心动图一次.术前与术后指标做对比分析.结果：TAPSE术前（20.25±3.05）mm,术后1w、术后3、6及术后12个月分别为（8.68±2.83） mm,（9.13 ±3.12）mm,（9.20 ±2.46） mm,（9.29±2.58）mm,术前和术后差异有统计学意义（P＜0.01）.TAPSV术前（17.8±4.00） cm/s,术后分别为（9.17 ±2.32） cm/s,（10.12 ±2.06） cm/s,（10.85 ±3.11） cm/s,（11.86 ±3.13） cm/s,术前和术后差异有统计学意义（P＜0.01）.术前RVAC为（45.62±4.32）％,与术后（46.21±3.89）％,（48.45±4.02）％,（47.33±3.86）％及（47.92 ±4.33）％相比,差异无统计学意义（P＞0.05）.术前及术后临床诊断均无右心功能不全.结论：TVP术后,经胸超声测量TAPSE、TAPSV低估了右心室收缩功能.在TVP术后不推荐使用其评价右心室收缩功能.

Tricuspid annular plane systolic excursion and tricuspid annular peak systolic velocity underestimate right ventricular systolic function after tricuspid annuloplasty

Objective：Aims of this study were to evaluate if tricuspid annular plane systolic excursion （TAPSE） and tricuspid annular peak systolic velocity （TAPSV） indicators could accurately reflect the postop- erative right ventricular systolic function in patients after mitral valve or aotic valve surgery combined with tri- cuspid annuloplasty ring. Methods：45 patients were studied, who underwent left heart valve surgery combined with tricuspid annuloplasty ring. Transthoracic echocardiography were performed pre-surgery and lweek, 3, 6, and 12 months post-surgery. In addition to routine preoperative and postoperative transthoracic echocardiography parameters, also measured RVAC, TAPSE, TAPSV. Comparatively analysised preoperative and postoperative in- dicators. Results： TAPSE preoperative （ 20. 25 ±3.05 ） mm, postoperative （ 8.68 ± 2. 83 ） mm, （ 9. 13 ± 3.12 ） mm, （9. 20 ±2.46） ram, （9. 29 ±2. 58）mm at lweek, 3, 6, and 12 months respectively and TAPSV preopera- tive（17.8 ± 4 ） cm/s, postoperative （ 11.93 ± 2. 32 ） cm/s, （ 12. 12 ± 2. 06 ） cm/s, （ 12. 85 ± 3.11 ） cm/s, （ 12. 86 ± 3.13 ） cm/s at lweek, 3, 6, and 12 months respectively）. Postoperative values were significantly （P 〈 0. 01 ） lower after surgery in comparison with pre-surgical values. On the contrary, pre-operative RVAC（45.62 ± 4. 32） % did not change significantly after surgery （46. 21 ± 3.89 ） %, （48.45 ± 4. 02 ） %, （ 47. 33 ± 3.86） % and （47. 92 ± 4. 33 ）% at each step. Conclusion： Right ventricular function evaluation indicators TAPSE and TAPS underestimates right ventricular systolic function after after mitral valve or aotic valve sur- gery combined with tricuspid annuloplasty ring. So, TAPSE and TAPSV were not recommended to evaluate right ventricular systolic function after after tricuspid annuloplasty.