实时三维超声心动图检测房间隔缺损封堵术对右心室容积和瓣环运动影响

目的 采用实时三维超声心动图(TR-3DE)评价房间隔缺损(ASD)封堵术对右心房室结构和瓣环运动的影响。方法 收集37例经ASD封堵术封堵成功的继发孔型ASD患者,于术前1天、术后1个月和3个月行TR-3DE检查,分析并比较封堵术前后右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)、右心房舒张末期容积(RAEDV)、右心房收缩末期容积(RAESV)、右心室射血分数(RVEF)和三尖瓣环位移(TAD)差异,计算术后3个月RVEDV、RVESV、RAEDV、RAESV变化率,分析术后右心容积变化率与封堵器直径、房间隔心内膜垫残端与三尖瓣环位移的相关性。结果 封堵术后1个月和3个月RVEDV、RVESV、RAEDV、RAESV、RVEF和TAD均显著低于术前,术后3个月和1个月间差异亦有统计学意义。封堵器直径与RVEDV,RVESV,RAEDV和RAESV变化率均呈正相关(r=0.98、0.89、0.87、0.87,P<0.05),心内膜垫残端与三尖瓣环位移无明显相关性(r=0.18,P>0.05)。结论 ASD患者封堵术治疗后右心室容量及三尖瓣环位移较术前均明显减小,可通过TR-3DE进行有效检测。

Real-time three-dimensional echocardiography in assessing effect of atrial septal defect occlusion on right ventricular volume and mitral annular motion

Objective To evaluate the effect of atrial septal defect (ASD) occlusion on right ventricular structure and motion of the mitral annulus using real-time three-dimensional echocardiography (TR-3DE). Methods Thirty-seven patients receiving ASD occlusion underwent TR-3DE 1 day before, 1 and 3 months after operation. Right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV), right atrial end diastolic volume (RAEDV), right atrial end systolic volume (RAESV), right ventricular ejection fraction (RVEF), and tricuspid annular displacement (TAD) were measured and compared between pre- and post-operation; and the change rate of RVEDV, RVESV, RAEDV and RAESV 3 months after operation were calculated. The correlations between volume change rate of right heart and the occlude size, the endocardial cushion stump and TAD were analyzed. Results One and 3 months after operation, RVEDV, RVESV, RAEDV, RAESV and RVEF all decreased compared with preoperation, and there were also significant differences between 1 and 3 months after operation (all P<0.05). The occlude size was positively correlated with change rate of RVEDV, RVESV, RAEDV and RAESV, respectively (r=0.98, 0.89, 0.87, 0.87, P<0.05) and the endocardial cushion stump was no correlated with TAD (r=0.18, P>0.05). Conclusion In ASD patients, the right ventricular volume and TAD both significantly reduce after occlusion compared with preoperation, which can be effectively detected by TR-3DE.