房间隔缺损封堵术对左心室结构和功能影响的超声应变率研究

摘要

Objective To study the changes of left ventricular structure and function after transcatheter closure of atrial septal defect(ASD)by strain rate(SR)imaging.Methods Twenty-eight patients with secundum type ASD were undergone transcatheter closure.Left and right ventricular end-diastolic diameter(LVED and RVED),left ventricular ejection fraction(LVEF),the Doppler transmitral filling velocities(E values and A values)and tricuspid regurgitation pressure were measured respectively at pre-operation,3 days,1 month and 3 months of post-operation.According to tricuspid regurgitation pressure,systolic pulmonary artery pressure(SPAP)was estimated.SR curves in all segments of left ventricular walls were acquired for all patients.The SR values including the peak of systolic SR,early-diastolic SR,late-diastolic SR were measured respectively.ResultsAfter operation,LVED,LVEF,E values and A values increased significantly while RVED and SPAP decreased.Almost all left ventricular walls' SR increased at post-operation except that SR of interventricular septeum(IVS)and left ventricular post wall(LVPW)decreased at 3 days,1 month of post-operation.Conclusions LV systolic and diastolic function are improved after operation,but SR characteristic changes of IVS and LVPW is the one of the most unique characters.%目的 应用应变率显像技术研究房间隔缺损(ASD)封堵术对左室结构和功能的影响.方法 28例继发孔型ASD成功进行封堵的患者,分别于术前及术后3 d、1个月、3个月测量左、右心室舒张末期内径(LVED和RVED)和左室射血分数(LVEF);脉冲多普勒测量二尖瓣口舒张期早期峰值流速、舒张晚期峰值流速(E峰、A峰)和三尖瓣口反流压差,并估测肺动脉收缩压(SPAP).应变率显像测量左室壁各节段收缩期应变率、舒张早期应变率和舒张晚期应变率.结果 封堵术后LVED、LVEF、E峰和A峰增大RVED减小;SPAP降低.左室壁各节段收缩期和舒张期应变率除室间隔及后壁应变率术后3 d、1个月降低,术后3个月增加外,其余均增强.结论 ASD封堵术后心肌舒缩功能增强,而室间隔与后壁舒缩功能的应变率指标呈先弱后强的变化是其功能改变的特征之一.