瓣环位移追踪技术评价房间隔缺损封堵术后右室功能的变化

发布时间：2018-04-10 11:44

本文选题：房间隔缺损 + 封堵术　；参考：《山西医科大学》2014年硕士论文

【摘要】：研究背景房间隔缺损（atrial septal defects，ASD）是最常见的先天性心脏病之一，其最主要的病理生理特征是心房水平存在左向右的分流。由于长期存在左向右分流，可引起慢性右心系统容量负荷过重、肺动脉高压，进而影响右心室功能。因此，准确评价右心室功能对于ASD患者的诊断、治疗及预后都有重要的意义。目前评价右心室功能的方法有超声心动图、CT成像、磁共振成像、放射性核素显像及心室造影等，由于超声心动图检查具有便捷、无创伤和无放射损害等优点，成为对右心系统形态、血流及功能进行评估的最便利、有效的首选方法[1]。超声心动图评价右心室收缩功能的方法有很多，组织运动瓣环位移自动追踪技术(tissue motion annular displacement, TMAD)是近些年发展起来的新技术，相关研究表明TMAD测定三尖瓣环位移(tricuspid annular displacement, TAD)方法简单、可重复性好，可作为评价右心室收缩功能的新方法[2,3]。目的应用组织运动瓣环位移自动追踪技术（TMAD）测定三尖瓣环位移（TAD）评价房间隔缺损（ASD）患者介入封堵术前后右心室收缩功能的变化，探讨TMAD技术的临床应用价值。方法研究对象为25例成功进行介入封堵的继发孔型ASD患者，分别于术前、术后3d、术后1个月、术后3个月、术后6个月行超声检查，，二维超声常规测量右心室前后径（rightventricular, RV）、右心房左右径（right atrium, RA）、主肺动脉内径（main pulmonary artery,MPA）及右心室射血分数（right ventricular ejection fraction, RVEF）；应用TMAD技术测量在上述各时间点三尖瓣环右室游离壁处、室间隔处及二者连线中点处相对于右室心尖部的收缩期峰值位移（T1、T2、Tm），并对测量结果进行分析比较。结果与术前相比：①术后不同时间点RA、RV、MPA逐渐减小，差异有统计学意义（P＜0.05）；②术后不同时间点RVEF有所增大，但差异无统计学意义（P＞0.05）；③术后不同时间点T1、Tm逐渐增大，差异有统计学意义（P＜0.05）；术后不同时间点T2有所增大，但差异无统计学意义（P＞0.05）。结论1、ASD封堵治疗术后，随时间推移右心系统结构和功能逐渐改善。2、TMAD技术可用于评估ASD封堵术后右心室收缩功能的改善状况。3、TAD测量方法简便，其中T1、Tm可作为定量评价ASD封堵术前后右心收缩功能的新指标。
[Abstract]:Background atrial septal defenses (ASD) is one of the most common congenital heart diseases. The main pathophysiological feature of ASD is left to right shunt at atrial level.The long-term left to right shunt may cause chronic right ventricular system volume overload, pulmonary hypertension, and then affect the right ventricular function.Therefore, accurate evaluation of right ventricular function plays an important role in the diagnosis, treatment and prognosis of ASD patients.At present, the methods of evaluating right ventricular function include echocardiography CT imaging, magnetic resonance imaging, radionuclide imaging and ventricular angiography.It is the most convenient and effective method to evaluate the shape, blood flow and function of right heart system [1].There are many methods for evaluating right ventricular systolic function by echocardiography. Tissue motion annular displacement (TMAD) is a new technique developed in recent years. It is a simple method to measure tricuspid annular displacement (tad) by TMAD.It has good reproducibility and can be used as a new method for evaluating right ventricular systolic function.Objective to evaluate the changes of right ventricular systolic function in patients with atrial septal defect (ASD) before and after transcatheter closure (ASD) by automatic tracking of tissue movement annular displacement (TMAD), and to evaluate the clinical application value of TMAD technique in patients with atrial septal defect (ASD).Methods Twenty-five patients with secondary perforated ASD who were successfully occluded by interventional occlusion were examined by ultrasound before operation, 3 days after operation, 1 month after operation, 3 months after operation and 6 months after operation.The peak systolic displacement of T _ (1) T _ (2) T _ (2) T _ (m) in the septum and the midpoint of the interventricular septum with respect to the right ventricular apical region was analyzed and compared.Results compared with preoperative, RV MPA decreased gradually at different time points after operation (P < 0.05), and RVEF increased at different time points after operation (P < 0.05), but there was no significant difference (P > 0.05) at different time points after operation.The difference was statistically significant (P < 0.05), and T2 increased at different time points after operation, but the difference was not statistically significant (P > 0.05).Conclusion 1 after ASD occlusion, the structure and function of right ventricular system gradually improved with time. TMAD technique can be used to evaluate the improvement of right ventricular systolic function after ASD occlusion.T1Tm can be used as a new index for quantitative evaluation of right ventricular systolic function before and after ASD occlusion.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R541.1

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