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应用组织多普勒技术评价房间隔缺损微创封堵术右心室室壁运动变化

Tissue Doppler Technique Used for the Evaluation of the Right Ventricular Wall Movement in the Intraoperative Device Closure of Atrial Septal Defects

作者: 张丽华  米彦军  王岩  刘爱琴  封淑文  黄建新 
单位:武警北京总队第二医院 (北京 100037)
关键词: 组织多普勒;右心室室壁运动;房间隔缺损;微创外科封堵;评价   
分类号:
出版年·卷·期(页码):2011·30·6(635-637)
摘要:

目的 通过应用组织多普勒技术监测微创外科房间隔缺损封堵术前后右心室室壁的运动变化并结合相应的功能评价,探讨组织多普勒技术在微创外科房间隔缺损封堵术中的应用价值。方法 分别于术前及术后3~5d对65例选择进行微创外科继发孔房间隔缺损封堵术治疗的患者进行经胸超声心动图检查,应用组织多普勒频谱图测量右室侧壁基底部(三尖瓣环处)、中间部以及室间隔基底部(三尖瓣环处)、中间部的室壁分别在收缩期、舒张早期和舒张晚期的峰值速度,并应用组织多普勒M型技术对左室长轴切面室间隔中部的运动变化情况进行封堵前后对照比较。结果 与术前比较,术后右室侧壁及室间隔的收缩期室壁运动峰值速度(s′)、舒张晚期组织运动峰值速度(a′)均显著减低(P<0.01);右室侧壁及室间隔中间部舒张早期运动峰值速度(e′)也较术前明显减低(P<0.01);术后所有患者室间隔中部与左室后壁的同向运动现象均得到明显改善或消失。结论  组织多普勒技术能够准确评价微创外科房间隔缺损封堵术后右室壁的运动变化,可为临床评价手术效果提供参考。

Objective To evaluate the clinical value of tissue Doppler in minimal-invasive surgical device closure of atrial septal defects, the tissue Doppler was utilized for measuring the movement of right ventricular wall. Methods Echocardiography tests were performed before operation and 3 to 5 days after the operation while 65 patients with secundum atrial septal defects underwent minimal-invasive surgical device closure. The tissue Doppler velocity spectra were detected to measure the movement of tricuspid annulus and middle part of right ventricle. Systolic peak velocity(s′), early diastolic peak velocity (e′) and late diastolic peak velocity (a′) of tricuspid annulus and middle part of right ventricle were analyzed, and M mode tissue Doppler of interventricular septum and left ventricular posterior wall were analyzed as well. Results Compared with the preoperation values, the after operation values of the systolic peak velocity(s′) and late diastolic peak velocity (a′) of tricuspid annulus decreased significantly (P<0.01),and early diastolic peak velocity (e′) of right ventricle also decreased significantly (P<0.01). And the abnormal motion of interventricular septum was improved after the closure of atrial septal defects. Conclusions Tissue Doppler is supposed as a tool in evaluating the changes of right ventricular motion in minimal-invasive surgical device closure of secundum atrial septal defects.

参考文献:

[1]Figueroa MI, Balaguru D, McClure C, et al. Experience with use of multiplance  transesophageal echocardiography to guide closure of atrial septal defects using the amplatzer device[J]. Pediatr Cardiol , 2002,23:430-436.
[2]卢旺盛,田增民.机器人在外科领域应用现状[J].北京生物医学工程,2010,29(1):101-105.
[3]Otani H , Kagaya Y, Yamane Y, et al. Long-term right ventricular volume overload increases myocardial fluorideoxy glucose uptake in the interventricul arseptum in patients with atrial septal defect[J] . Circulation, 2000,101(14):1686-1692.
[4]张妍,王珂,刘晓萍,等. 房间隔缺损封堵术后右心形态和功能变化的随访观察[J]. 中国循环杂志, 2002,17(4):290-291.
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