三维超声心动图评价老年房间隔缺损封堵术前后左右心室收缩功能
发布时间：2019-05-24 23:55
【摘要】：背景：早先房间隔缺损（ASD）后确诊采取开胸修补手术治疗创伤大并存在一定危险性，成人特别是老年ASD患者多不愿接受；近年封堵术介入治疗ASD创伤小危险性低，逐渐被许多成人甚至是老年患者接受。以往有学者应用M型和二维超声心动图（2DE）测定ASD手术前后心室功能，目前尚无应用三维超声心动图（3DE）评价老年ASD封堵术前后左右心室收缩功能的报道，本研究即是采用3DE技术对老年ASD封堵术介入治疗前后心室收缩功能进行评价。 目的：应用3DE评价老年ASD封堵术前后左右心室收缩功能变化。 材料和方法：本研究从2010年3月至2014年3月，在沈阳军区总医院住院的35例老年孤立性ASD患者，其中男性7例，女性28例，年龄60至75岁（平均64.2岁）。ASD直径最小8mm，最大28mm，平均18.2mm，ASD六个缘（上下缘、前后缘和上下腔静脉缘）长度均≥7mm，其中伴有轻-中度肺动脉高压12例，肺动脉收缩压力均在60mmHg以内，心房水平均为左向右分流，伴有轻度二尖瓣关闭不全11例，伴有轻-中度二尖瓣关闭不全5例，伴有轻度三尖瓣关闭不全12例，伴有轻度-中度三尖瓣关闭不全6例。使用PhilipsiE33型彩色多普勒超声心动图（CDE）诊断仪，具有M型超声心动图、2DE、脉冲多普勒（PW）、连续多普勒（CW）和彩色多普勒血流显像（CDFI）五种常用功能，探头频率1～5MHz，另配1个X3-1探头。分别在封堵术前1天、封堵术后1天、1周、1个月、3个月和6个月进行2DE及3DE检查。先应用M型超声心动图和2DE进行常规检查，测量各参数；应用2DE测量ASD直径，CDFI显示过房间隔彩色分流束，判断ASD大小；应用CDFI观察过心脏瓣膜反流情况，判断关闭不全的程度；再应用CW测定三尖瓣反流频谱，获取速度峰值，根据简化的伯努利方程（ΔP=4V2）估测肺动脉压力值。最后更换X3-1探头行3DE检查，分别对左右心室进行取样获取三维数据库，随后脱机使用Qlab软件进行处理分析，依次采集手术前和手术后左室舒张末期容积、左室收缩末期容积、左室每搏输出量以及左室射血分数（即LVEDV、LVESV、LVSV以及LVEF）；右室舒张末期容积、右室收缩末期容积、右室每搏输出量以及右室射血分数（即RVEDV、RVESV、RVSV以及RVEF）。将封堵术前后检测上述数值进行统计学成对t检验，比较两组间差异，P㩳0.05差异性显著。 结果：35例老年ASD在CDE实时监视下均成功实施封堵术介入治疗，术后CDE复查无并发症，所有患者封堵器位置及形态均正常，无残余分流。3DE测定LVEDV、LVESV以及LVSV从封堵术后1天开始逐渐增大；封堵术介入治疗后1周、术后1个月、术后3个月、术后6个月与封堵术前相比较上述测值均明显增大（P㩳0.01）；术后1个月与术后1天相比较，差异性显著（P㩳0.01）；封堵术介入治疗后6个月与封堵术介入治疗后术后1个月相比较，差异性不显著（P㧐0.05）。RVEDV、RVESV以及RVSV从介入封堵术后1天开始逐渐缩小；封堵术介入治疗后1周、术后1个月、术后3个月、术后6个月与封堵术介入治疗前相比较上述测值均明显缩小，术后1个月与术后1天相比较，，差异性显著（P㩳0.01）；术后6个月与术后1个月相比较，差异性不显著（P㧐0.05）；LVEF、RVEF封堵术介入治疗术前与术后相比较，差异性不显著（P㧐0.05）。 结论：老年ASD封堵术介入治疗后由于阻断心房水平异常分流，从术后1天左右心室的容积即发生改变，且1天至1个月内改变明显，从1个月以后开始趋于稳定，LVEF和RVEF封堵术后改变不明显。3DE技术评价心功能具有简便、快速、更准确等优点，应用3DE测定老年ASD封堵术前后心功能可取代有创的心血管造影检查。
[Abstract]:BACKGROUND: The diagnosis of atrial septal defect (ASD) after atrial septal defect (ASD) has a high degree of trauma and a certain risk, especially in elderly patients with ASD. In recent years, the small risk of ASD is low and is gradually accepted by many adults and even older patients. In the past, the ventricular function before and after ASD was measured by using M-type and two-dimensional echocardiography (2DE), and no three-dimensional echocardiography (3DE) was used to evaluate the left and right ventricular systolic function of the elderly ASD. This study is to evaluate the ventricular systolic function before and after the interventional treatment of the elderly ASD with the 3DE technique. Objective: To evaluate the effect of 3DE in the treatment of left and right ventricular contraction in elderly patients with ASD. Materials and Methods: From March 2010 to March 2014,35 elderly patients with isolated ASD were hospitalized in the General Hospital of Shenyang Military Region, including 7 males and 28 females, aged 60 to 75 years (average 64). The diameter of ASD was 8 mm, the maximum 28 mm, the average of 18.2 mm, the length of the six edges of the ASD (upper and lower, anterior and inferior vena cava) was 7 mm, with 12 cases of light-to-moderate pulmonary hypertension, and the systolic pressure of the pulmonary artery was within 60 mmHg, and the atrial level was left to the left. Right shunt with mild mitral insufficiency in 11 cases with mild-to-moderate mitral insufficiency in 5 cases with mild tricuspid insufficiency in 12 cases with mild-to-moderate tricuspid valve closure A total of 6 cases were used. There are five common functions of M-type echocardiography, 2DE, pulse Doppler (PW), continuous Doppler (CW) and color Doppler flow imaging (CDFI). The frequency of the probe is 1-5 MHz and the other is X3- 1 probe.2 DE and 3 D for 1 day,1 week,1 month,3 months and 6 months after the occlusion, respectively,1 day before closure. E. First, use M-type echocardiography and 2DE for routine examination to measure the parameters; apply 2DE to measure ASD diameter, CDFI to display the transseptal color shunt, and judge the size of ASD; and observe the heart valve regurgitation by using CDFI and judge the insufficiency. To the extent that the frequency spectrum of the tricuspid regurgitation was measured by CW, the peak value was obtained, and the pulmonary artery was estimated according to the simplified Bernoulli equation (Supp = 4V2). The pressure value was measured. Finally, the three-dimensional database was sampled for the left and right ventricles, and then the left ventricular end-diastolic volume and the left ventricular end-systolic volume were collected before and after the operation. Phase volume, left ventricular stroke volume, and left ventricular ejection fraction (i.e., LVEDV, LVESV, LVSV, and LVEF); right ventricular end-diastolic volume, right ventricular end-systolic volume, right ventricular stroke volume, and right ventricular ejection fraction (i.e., RVEDV, RVESV, RVSV, and RV EF). The above-mentioned values were tested for statistical paired t-test before and after the plugging operation, and the difference between the two groups was compared, and the difference between the two groups was P-0.05. Results:35 elderly patients with ASD were successful in the interventional treatment under the real-time monitoring of CDE. The postoperative CDE reexamination had no complications, and the position and morphology of all the patients were normal and there was no residual shunt. The results showed that the LVEDV, LVESV and LVSV were open after the occlusion. The results were gradually increased,1 month after operation,1 month after operation,3 months after operation,6 months after operation, and 3 months after operation, the above measured values were significantly increased in 6 months after operation (P <0.01), and the difference was significant after 1 month after operation and 1 day after operation (P? 0.01). The difference was not significant (P? 0.05) after 6 months after the interventional treatment and 1 month after the operation. The RVEDV, the RVESV and the RVSV were gradually reduced from one day after the intervention. The occlusion was 1 week after the interventional treatment and one month after the operation. Compared with the one-day post-operation, the difference was not significant (P? 0.05). LVEF and RVEF were compared with operation before and after operation, and the difference was not significant (P? Conclusion: After the interventional treatment of the elderly ASD, the volume of the left ventricle is changed from 1 day to 1 month due to the abnormal shunt of the blocking of the atrial level, and the change is obvious from 1 day to 1 month, from 1 month to 1 month. The results showed that the changes of cardiac function were simple, rapid, and more accurate in the treatment of the cardiac function with 3DE, and the cardiac function before and after the closure of the ASD was replaced by the 3DE technique.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R540.45;R654.2
[Abstract]:BACKGROUND: The diagnosis of atrial septal defect (ASD) after atrial septal defect (ASD) has a high degree of trauma and a certain risk, especially in elderly patients with ASD. In recent years, the small risk of ASD is low and is gradually accepted by many adults and even older patients. In the past, the ventricular function before and after ASD was measured by using M-type and two-dimensional echocardiography (2DE), and no three-dimensional echocardiography (3DE) was used to evaluate the left and right ventricular systolic function of the elderly ASD. This study is to evaluate the ventricular systolic function before and after the interventional treatment of the elderly ASD with the 3DE technique. Objective: To evaluate the effect of 3DE in the treatment of left and right ventricular contraction in elderly patients with ASD. Materials and Methods: From March 2010 to March 2014,35 elderly patients with isolated ASD were hospitalized in the General Hospital of Shenyang Military Region, including 7 males and 28 females, aged 60 to 75 years (average 64). The diameter of ASD was 8 mm, the maximum 28 mm, the average of 18.2 mm, the length of the six edges of the ASD (upper and lower, anterior and inferior vena cava) was 7 mm, with 12 cases of light-to-moderate pulmonary hypertension, and the systolic pressure of the pulmonary artery was within 60 mmHg, and the atrial level was left to the left. Right shunt with mild mitral insufficiency in 11 cases with mild-to-moderate mitral insufficiency in 5 cases with mild tricuspid insufficiency in 12 cases with mild-to-moderate tricuspid valve closure A total of 6 cases were used. There are five common functions of M-type echocardiography, 2DE, pulse Doppler (PW), continuous Doppler (CW) and color Doppler flow imaging (CDFI). The frequency of the probe is 1-5 MHz and the other is X3- 1 probe.2 DE and 3 D for 1 day,1 week,1 month,3 months and 6 months after the occlusion, respectively,1 day before closure. E. First, use M-type echocardiography and 2DE for routine examination to measure the parameters; apply 2DE to measure ASD diameter, CDFI to display the transseptal color shunt, and judge the size of ASD; and observe the heart valve regurgitation by using CDFI and judge the insufficiency. To the extent that the frequency spectrum of the tricuspid regurgitation was measured by CW, the peak value was obtained, and the pulmonary artery was estimated according to the simplified Bernoulli equation (Supp = 4V2). The pressure value was measured. Finally, the three-dimensional database was sampled for the left and right ventricles, and then the left ventricular end-diastolic volume and the left ventricular end-systolic volume were collected before and after the operation. Phase volume, left ventricular stroke volume, and left ventricular ejection fraction (i.e., LVEDV, LVESV, LVSV, and LVEF); right ventricular end-diastolic volume, right ventricular end-systolic volume, right ventricular stroke volume, and right ventricular ejection fraction (i.e., RVEDV, RVESV, RVSV, and RV EF). The above-mentioned values were tested for statistical paired t-test before and after the plugging operation, and the difference between the two groups was compared, and the difference between the two groups was P-0.05. Results:35 elderly patients with ASD were successful in the interventional treatment under the real-time monitoring of CDE. The postoperative CDE reexamination had no complications, and the position and morphology of all the patients were normal and there was no residual shunt. The results showed that the LVEDV, LVESV and LVSV were open after the occlusion. The results were gradually increased,1 month after operation,1 month after operation,3 months after operation,6 months after operation, and 3 months after operation, the above measured values were significantly increased in 6 months after operation (P <0.01), and the difference was significant after 1 month after operation and 1 day after operation (P? 0.01). The difference was not significant (P? 0.05) after 6 months after the interventional treatment and 1 month after the operation. The RVEDV, the RVESV and the RVSV were gradually reduced from one day after the intervention. The occlusion was 1 week after the interventional treatment and one month after the operation. Compared with the one-day post-operation, the difference was not significant (P? 0.05). LVEF and RVEF were compared with operation before and after operation, and the difference was not significant (P? Conclusion: After the interventional treatment of the elderly ASD, the volume of the left ventricle is changed from 1 day to 1 month due to the abnormal shunt of the blocking of the atrial level, and the change is obvious from 1 day to 1 month, from 1 month to 1 month. The results showed that the changes of cardiac function were simple, rapid, and more accurate in the treatment of the cardiac function with 3DE, and the cardiac function before and after the closure of the ASD was replaced by the 3DE technique.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R540.45;R654.2
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