单心动周期实时三维超声评价房间隔缺损患者右心室形态及功能

目的探讨房间隔缺损患者右心室形态及功能的改变。方法入组33例健康志愿者（对照组,即NOR组）及18例接受介入治疗的房间隔缺损患者（病例组,即ASD组）,均行常规超声心动图检查,应用单心动周期实时三维超声心动图评价所有研究对象右心室形态及收缩功能的相关参数,并以体表面积加以校正。ASD组右心室相关参数与导管所测心腔压力、校正房间隔缺损最大径（IASD）对照进行相关性研究。结果ASD组校正后的右心室舒张末容积（IEDVRV）、右心室收缩末容积（IESVRV）、右心室每搏输出量（ISVRV）以及右心室射血分数（RVEF）均显著大于对照组（P〈0.001,P〈0.01,P〈0.001,P〈0.05）。且其右心室形态相关参数（IEDVRV、IESVRV、ISVRV）与右心导管所测肺动脉压力呈正相关,以与肺动脉舒张压相关性最为显著（r=0.79,r=0.61,r=0.83,均P〈0.01）;与IASD呈正相关（r=0.57,P〈0.05;r=0.60,P〈0.01;r=0.55,P〈0.05）;而与左心室射血分数（LVEF）呈负相关（r=-0.47,r=-0.50,r=-0.52,均P〈0.05）。结论房间隔缺损患者存在的左向右分流导致了肺动脉压力的进行性增高及与之平行的右心室容量进行性增大。右心室形态学的改变使右心室收缩力增强,并导致左心室形态学改变以及左心室心功能的变化。

Assessments of modality and function right ventricular in patients with arial septal defect by single cardiac cycle real-time three dimensional echocardiography

Objective To investigate the shape and function of right ventricle in patients with arial septal defect. Methods Thirty-three healthy volunteers and 18 ASD patients were enrolled consecutively as normal controls and the ASD group respectively. All the participants received routine echocardiography. Single cardiac cycle real-time three dimensional eehocardiography （sRt-3DE） were performed in all to evaluate parameters concerning modality and systolic function of participants＇ right ventricle. All the parameters were indexed by body surface area （ BSA ）. Further correlative analysis was calculated between right ventricular parameters and right heart pressure by cardiac catheter as well as right ventricular parameters and BSA indexed maximum diameter of ASD. Results Indexed right ventricular end diastolic volume （ IEDVRV ） and end systolic volume （IESVRV）, indexed right ventricular systolic volume （ISVRV） and right ventrieular ejection fraction （RVEF） were greater in the ASD group than in controls （P 〈0. 001 ,P 〈0.01 ,P 〈0. 001, P 〈0. 05）. IEDVRV, IESVRV and ISVRV had positive relation with pulmonary pressure measured by cardiac catheter （ r = 0. 61 ,r = 0. 79, r = 0. 83, all P 〈 0. 01 ） and IASD （ r = 0. 57, P 〈 0. 05 ; r = 0. 6, P 〈 0. 01 ; r =0. 55 ,P 〈0. 05 respectively） while they had negative relation with LVEF （ r = -0. 47, r = - 0. 5, r = - 0. 52 ; all P 〈 0. 05 ）. Conclusions Left-to-right shunt in ASD patients may lead to an aggressive increase of pulmonary pressure and right ventricular volume. The enlargement of right ventricle increases right ventricular contraction. Meanwhile, it affects the modality and function of left ventricle.