超声应变显像在房间隔缺损封堵术中的应用

【摘要】  目的 应用超声应变显像技术（SI）评价房间隔缺损(ASD)封堵术前、术后心脏功能的变化。方法选取接受Amplataer封堵器治疗的继发孔型ASD病人50例，分别于ASD封堵术前3 d、术后1周、术后3个月，应用SI在心尖四腔切面测量各房室腔大小、肺动脉收缩压（PASP），右室侧壁三尖瓣环处、右室侧壁中部、室间隔二尖瓣环处、室间隔中部、左室侧壁二尖瓣环处以及左室侧壁中部收缩期峰值应变（Ss）。选择健康志愿者50例作为对照组。结果 与对照组比较，ASD组右心房（RA）横径、右心室（RV）横径、PASP增大，差异有显著性（t=2.23～2.87,P<0.05）;与术前比较，术后1周RA横径、 RV横径、 PASP显著减小，术后3个月RA横径、 RV横径、PASP进一步减小，差异有显著性(F=7.58～13.46,q=3.50～3.98,P<0.05)。与对照组比较，ASD组术前右室壁和室间隔、左室侧壁二尖瓣环处Ss显著增大，差异有显著性（t=2.04～2.97,P<0.05）。与封堵术前比较，术后1周右室侧壁、室间隔中部Ss均显著降低(F=8.57～14.66,q=3.67～4.90,P<0.05)，术后3个月右室侧壁、室间隔和左室壁Ss均显著降低(q=3.46～3.86,P<0.05)；与封堵术后1周比较，术后3个月右室侧壁中部Ss显著降低(F=14.59,q=3.46,P<0.05)。结论 SI可准确、定量评价房间隔缺损封堵术前、术后心脏功能的变化,评价封堵术的治疗效果。 
【关键词】  超声心动描记术;心脏导管插入术;房间隔缺损;治疗结果
　　［ABSTRACT］ObjectiveTo assess cardiac function by strain imaging (SI) in patients with atrial septal defects (ASD) undergoing device closure.MethodsFifty patients with secondary isolated ASD undergoing device closure and 50 healthy controls were enrolled in this study. Using SI technique, the transverse diameters (TD) of all chambers and pulmonary artery systolic pressure (PASP) were measured at the apex of heart, and the systolic strain peaks (SSPs) were measured in tricuspid annulus, middle part of right ventricle (RV), mitral annulus, middle part of ventricular septum, mitral annulus and middle part of left ventricle (LV), three days before, one week and three months after the procedure.ResultsCompared with the controls, the TD of right chambers and PASP in the patients were significantly increased (t=2.23-2.87,P<0.05); compared with pre?surgery, the above parameters were decreased one week after the closure, which were further decreased three months later (F=7.58-13.46,q=3.50-3.98,P<0.05). The SSPs of RV wall, of ventricular septum and mitral annulus of LV were significantly increased before defect closure, compared with that of the controls (t=2.04-2.97,P<0.05). The SSPs of RV wall and the middle part of ventricular septum were decreased one week after the procedures (F=7.58-13.46,q=3.67-4.90,P<0.05). The SSPs of the RV wall, the ventricular septum and the LV wall decreased further after three months (q=3.50-3.98,P<0.05). The SSPs of the middle part of RV were significantly lower three months after device closure than one week after that (F=14.59,q=3.46,P<0.05).ConclusionStrain imaging can accurately and quantitatively evaluate the cardiac function changes in patients before and after ASD closure.
    ［KEY WORDS］Echocardiography; Heart catheterization; Atrial septal defects; Treatment outcome
    超声应变显像技术（SI）是在定量组织多普勒基础上发展起来的新技术,时间分辨率高,能够同时定量分析多节段心肌运动,将局部心肌功能的检测提高到了一个新台阶[1]。本研究应用SI观测房间隔缺损(ASD)封堵病人术前和术后心肌部分节段参数变化以评价其疗效及恢复情况，现报告如下。