心房颤动患者冷冻消融联合左心耳封堵术后左心房结构和功能的超声心动图评价

目的应用超声心动图评价阵发性心房颤动患者冷冻消融联合左心耳封堵（CA+LAAC）术前、术后左心房结构和功能的变化。 方法选取2019年9月至2021年3月于辽宁省人民医院行“一站式”手术（CA+LAAC）的患者26例。所有患者分别于术前1周内、术后3个月行超声心动图检查评价左心房的结构和功能。行常规超声心动图检查,测量常规超声心动图参数：左心房前后径（LAD）、左心房最大容积（LAVmax）、左心房最小容积（LAVmin）、左心室射血分数（LVEF）、左心室舒张早期二尖瓣口血流速度（E峰）、二尖瓣环侧壁和房间隔侧舒张早期运动速度的平均值（e'）。并计算左心房最大容积指数（LAVImax）、左心房最小容积指数（LAVImin）、左心房射血分数（LAEF）、左心房扩张指数（LAEI）及E/e'。应用二维斑点追踪超声心动图（2D-STI）在心尖四腔心和心尖两腔心切面测量左心房应变参数：心室收缩期左心房储备期纵向峰值应变（PALSres）,心室舒张早期左心房管道期纵向峰值应变（PALScond）及心室舒张晚期左心房泵功能期纵向峰值应变（PALSpump）。采用配对样本t检验比较术前与术后3个月超声心动图参数。 结果与术前相比,CA+LAAC手术后3个月,LAD、LAVmax、LAVmin、LAVImax、LAVImin减小,差异均有统计学意义（P均＜0.05）,LAEF、LAEI、LVEF,PALSres、PALScond、PALSpump与术前相比均增大,差异均有统计学意义（P均＜0.05）。 结论CA+LAAC术后3个月,阵发性心房颤动患者左心房的结构和功能均得到改善和恢复,超声心动图对于评估心房颤动患者左心房结构和功能具有良好的应用价值。

Evaluation of left atrial structural and function by echocardiography in patients with atrial fibrillation after combined catheter ablation and left atrial appendage closure

To evaluate left atrial structural and function changes using echocardiography in patients with paroxysmal atrial fibrillation before and after combined catheter ablation and left atrial appendage closure (CA+LAAC) as "one-stop" procedure. MethodsWe selected 26 patients who underwent the "one-stop" procedure at People's hospital of Liaoning province from September 2019 to March 2021 and evaluated their left atrial structural and function changes by echocardiography preoperatively and 3 months after "one-stop" procedure. Left atrial anteroposterior diameter (LAD), left ventricle diameter (LVD), left atrial maximum volume (LAVmax), left atrial minimum volume (LAVmin), left ventricular ejection fraction (LVEF), mitral valve inflow peak spectral velocity in left ventricular early diastole (E-wave), and the average of tissue velocity of mitral annulus on the ventricular septum and tissue velocity of mitral annulus on the lateral wall in left ventricular early diastole (e') were obtained by echocardiography. Left atrial maximum volume index (LAVImax), left atrial minimum volume index (LAVImin), left atrial ejection fraction (LAEF), left atrial expansion index (LAEI), and average E/e' value were calculated by conventional echocardiography. The peak longitudinal strain of the left atrium during reservoir phase (PALSres), the peak longitudinal strain of the left atrium during conduit phase (PALScond), and the peak longitudinal strain of the left atrium during booster pump phase (PALSpump) were measured using two-dimensional speckle tracking imaging (2D-STI) in the apical views of four and two chambers. The changes of left atrial structure and function in patients with paroxysmal atrial fibrillation before and after "one-stop" procedure were compared using the paired t test. ResultsCompared to preoperative values, LAD, LAVmax, LAVmin, LAVImax, and LAVImin significantly decreased at 3 months after the "one-stop" procedure (P＜0.05 for all), while LAEF, LAEI, LVEF, PALSres, PALScond, and PALSpump increased significantly (P＜0.05 for all). ConclusionThe left atrial structure and function in patients with paroxysmal atrial fibrillation after CA+LAAC recover three months after the "one-stop" procedure. Echocardiography has important clinical value in evaluating the changes of left atrial structure and function in patients with paroxysmal atrial fibrillation.