术前评估成人房间隔缺损合并器质性二尖瓣关闭不全

目的 探讨成人房间隔缺损（ASD）合并器质性二尖瓣关闭不全（MR）的特异性超声心动图表现。方法 收集372例接受ASD心内修复术的成人患者，根据是否同时或分期行二尖瓣成形术或置换术分为两组，即病例组（n=45）和对照组（n=327）。应用多因素回归法筛选ASD合并器质性MR的术前危险因素。结果 病例组患者左心室舒张末期内径（LVEDD）、左心房内径（LAD）、肺动脉内径（PAD）和二尖瓣瓣环内径明显大于对照组（P均<0.05）；二尖瓣和三尖瓣的舒张早期峰速（Em、Et）均明显高于对照组（P均<0.05）；二尖瓣环和三尖瓣环侧壁处的舒张晚期峰速（Am''、At''）、三尖瓣侧壁瓣环处收缩期运动峰速（St''）明显小于对照组（P均<0.05）；肺动脉收缩压（PASP）明显高于对照组（P=0.004），三尖瓣反流程度也明显大于对照组（P=0.002）。其中二尖瓣瓣环扩张、LVEDD增大、St''偏低和PAD明显扩张，是成人ASD合并器质性MR的独立危险因素。结论 二尖瓣瓣环内径明显扩大和LVEDD增大是ASD患者左心室前负荷增加的特异性超声心动图表现。

Preoperative assessment of atrial septal defect in adults complicated with pathological mitral regurgitation

Objective To explore the specific echocardiography features in adults atrial septal defect (ASD) complicated with pathological mitral regurgitation (MR).Methods Totally 372 adults patients with ASD were divided into two groups, case group (n=45, undergoing ASD closure concomitant mitral valvuloplasty or replacement) and control group (n=327, ASD closure alone). The preoperative risk factors of ASD were determined though multivariate regression analysis.Results The left ventricular end diastole diameter (LVEDD), left atrial diameter (LAD), pulmonary artery diameter (PAD) and mitral annulus diameter in case group were significant higher than those in control group (all P<0.05). Early diastolic peak velocity through mitral and tricuspid (Em, Et) in case group were significant higher than those in control group (both P<0.05). Lateral mitral and tricuspid annulus late diastolic peak velocity (Am'', At'') and lateral tricuspid annulus peak systolic velocity (St'') in case group were significant lower than those in control group (all P<0.05). Pulmonary artery systolic pressure in case group was significant higher than that in control group (P=0.004). The extent of tricuspid regurgitation in case group was significant higher than that in control group (P=0.002). Multivariable regression analysis revealed that the preoperative risk factors of ASD were mitral annulus dilated, LVEDD enlarged, St'' reduced and PAD dilated.Conclusion Mitral annulus and LVEDD significant dilated are the specificity echocardiography feature of left ventricular preload increased in adult ASD.