风湿性二尖瓣狭窄患者左心房流体力学观察

目的探讨风湿性二尖瓣狭窄(MS)患者发生心房颤动(AF)与左心房流体力学环境的关系.方法根据术前心律情况不同,将49例合并AF的MS患者分为2组,A组(n＝25):合并慢性AF,B组(n＝24):均为窦性心律;对照组:29例正常人作为对照.采用超声心动图检测3组左心房流体力学指标,术后6～8个月复查.结果术后A组左心房机械应力(LAS)、左心房面积(LAA)和左心房容积(LAV)均较术前降低或减少,B组LAS亦较术前明显降低(P＜0.01).术前A组LAS明显低于B组,LAA、LAV明显大于B组;术后A组LAA、LAV仍大于B组(P＜0.01).术前、术后A组、B组LAS、LAA、LAV均高于或大于对照组.结论 MS患者术后左心房流体力学环境远未恢复正常,LAS可能是导致MS患者发生AF的重要因素.

Observation of left atrial hydrodynamic change in patients with rheumatic mitral stenosis

Objective To investigate the correlation between the left atrial hydrodynamic change and atrial fibrillation (AF) in the patients with rheumatic mitral stenosis. Methods According to cardiac rhythm before operation, 49 patients with rheumatic mitral stenosis accompanying chronic AF were divided into two groups,group A: AF, 25 cases; group B: sinus rhythm, 24 cases. Control group : 29 healthy volunteers were examined. By using echocardiography, left atrial hydrodynamics were tested, and repeated 6-8 months after the operation. Results Left atrial stress (LAS), left atriala area (LAA) and left atrial volume(LAV) in group A after operation was much lower than before operation, LAS after operation in group B was also lower than before operation(P<0.01). Before operation, LAS in group A was significantly lower than that in group B, LAA and LAVwere larger. After operation, LAA and LAV in group A were significantly larger than those in group B(P<0.01). LAS, LAA and LAV in group A and group B before and after operation were higher than those in control group. Conclusion Left atrial hydrodynamic enviroment in patients with mitral stenosis has not reached normal even after valve replacement, LAS may be an important factor of causing AF.