超声评价慢性血栓栓塞性肺动脉高压患者肺动脉球囊成形术后右房功能

目的:应用超声诊断技术评价慢性血栓栓塞性肺动脉高压(Chronic thromboembolic pulmonary hypertension,CTEPH)患者肺动脉球囊成形术(Ballon angioplasty of pulmonary artery,BPA)术后右房功能的变化,结合血流动力学,对手术效果做出评价,...

Echocardiography evaluation of right atrial function after balloon angioplasty of pulmonary artery in patients with chronic thromboembolic pulmonary hypertension

Objective:To evaluate the changes of right atrial function in patients with chronic thromboembolic pulmonary hypertension(CTEPH)after balloon angioplasty of pulmonary artery(BPA),and to evaluate the surgical effect combined with hemodynamics,so as to provide clinical basis for diagnosis and treatment.Methods:Eighteen CTEPH patients who received BPA in Yantai Yuhuangding Hospital from November 2019 to January 2021 were selected.The cardiac structure and right atrial function parameters before and after operation were obtained by echocardiography:inferior vena cava collapse index(IVCCI),right atrial area(RAS),right atrial integral emptying fraction(RATEF),right atrial passive emptying fraction(RAPEF),right atrial active emptying fraction(RAAEF),right atrial functional index(RAFi).The strain parameters of right atrium were obtained by ultrasonic two-dimensional speckle tracking technique:the right atrial forward strain(RALSpos),the right atrial negative strain(RALSneg),the total of the absolute values of the positive and negative strains of the right atrium(RALStot),and the right atrial longitudinal strain rate(RALSR).Systolic pressure of pulmonary artery(PASP)was measured according to the maximum reflux velocity of the tricuspid valve and the right atrial pressure,diastolic pressure of pulmonary artery(PADP)and mean pressure of pulmonary artery(PAMP)were estimated by the pulmonary valve reflux velocity.Right atrial function,hemodynamics,serology and clinical sparameters were compared before and after BPA operation.Results:The IVCCI increased,the PASP,PADP,PAMP and RAS of CTEPH patients decreased after BPA(P<0.05),RATEF,RALStot,RALSpos,RALSR increased(P<0.01),RAFi increased(P<0.05).However,there were no significant changes in RAPEF,RAAEF,and RALSneg,the improvement in right atrial systolic function was not significant.The NYHA grade of cardiac function decreased(P<0.05)and the walking distance of 6 min increased(P<0.01).Single factor Logistic regression showed that the RATEF,RALStot,RALSpos,RALSR of right atrial functional parameters before operation had an effect on the curative effect of interventional surgery.Conclusion:Echocardiography can evaluate the changes of right atrial function and hemodynamics before and after BPA in CTEPH patients;and the improvement of right atrial function and the decrease of PASP,PADP,PAMP after BPA suggest that the BPA has better surgical effect.