25例主动脉瓣成形术后一年的超声心动图评价

doi:10.16150/j.1671-2870.2022.03.018

摘要/Abstract

摘要：

目的：分析主动脉瓣反流（aortic insufficiency, AI）患者接受主动脉瓣成形术（aortic valvuloplasty,AVP）后1年的经胸超声心动图（心超）检查结果,评价AVP的效果。方法：25例接受AVP治疗的AI患者在术后1年时行心超检查,测量心腔大小、左心室收缩及舒张功能、AI分级、收缩期经主动脉瓣口流速及跨主动脉瓣压差等指标,并与术前检查结果比较,从心超角度评价AVP手术疗效。结果：心超检查显示,患者AVP术后1年的左室舒张末期内径[术前（54.4±4.6） mm比术后（50.0±4.9） mm,P=0.003]、左室舒张末期容积[术前（145.7±28.8） mL比术后（120.4±27.8） mL, P<0.001]、左室收缩末期内径[术前34.0（31.0,38.0） mm 比术后31.0（29.5,34.0） mm,P<0.001]、左室收缩末期容积[术前47.0（37.5,63.0） mL比术后37.0（32.5,48.5） mL,P=0.005]、左室每搏输出量[术前（92.6±18.4） mL 比术后（78.4±17.8） mL,P<0.001]均显著缩小,AI程度显著减轻（P=0.021）,但主动脉瓣口血流速度及跨主动脉瓣压差的变化无统计学意义[术前（1.8±0.4） m/s比术后（1.7±0.4） m/s,P=0.086,术前（13.4±5.2） mmHg 比术后（11.6±5.7） mmHg,P=0.152]。AVP术后1年,25例患者中有5例AI评分≥3分。结论：AI患者AVP术后1年,中度及以上程度（AI评分≥3分）的反流发生率为20%,但总体患者AI程度显著减轻,左心室超负荷状态发生逆转,并伴随有利的左心室重构,与临床表现相符。

关键词: 主动脉瓣成形术, 超声心动图, 主动脉瓣反流复发

Abstract:

Objective: To investigate effect of surgical aortic valvuloplasty(AVP) for aortic insufficiency in patients using transthoracic echocardiography (TTE). Methods: A total of 25 patients underwent AVP surgery for aortic insufficiency(AI) were enrolled, and TTE was performed to evaluate effects of AVP. Cardiac chamber size, left ventricular(LV) systolic and diastolic function, AI grade, systolic transvalvular blood flow velocity and pressure gradient were measured one year after surgery, and results were compared to those before operation. Results: Echocardiographic measurements show that AVP, LV overload was reversed, Left ventricular end-diastolic diameter [(54.4±4.6) mm preoperatively vs ( 50.0±4.9) mm postoperatively, P=0.003), left ventricular end-diastolic volume[(145.7±28.8) mL preoperatively vs (120.4±27.8) mL pos-toperatively, P<0.001), left ventricular end-systolic diameter [34.0(31.0, 38.0) mm preoperatively vs 31.0(29.5, 34.0) mm postoperatively, P<0.001], left ventricular end-systolic volume [47.0(37.5, 63.0) mL preoperatively vs 37.0(32.5, 48.5) mL postoperatively, P=0.005], left ventricular stroke volume [(92.6±18.4) mL preoperatively vs (78.4±17.8) mL postoperatively, P<0.001] were significantly decreased, and the degree of aortic valve regurgitation was also significantly relieved (chi-square value is 21.000, P=0.021). However, there were no significant changes in aortic transvalvular flow velocity and pressure gradient [(1.8±0.4) m/s preoperatively vs (1.7±0.4) m/s postoperatively, P=0.086) and [(13.4±5.2) mmHg preoperatively vs (11.6±5.7) mmHg postoperatively, P=0.152). Postoperative regurgitation score ≥3 points were found in 5 cases. Conclusions: One year after AVP, the rate of moderate regurgitation in these patients is 20%. All AI is signifi-cantly alleviated after AVP, with reversed LV overload and accompanied by favorable LV remodelling, which is consistent with clinical manifestations.

Key words: Aortic valvuloplasty, Echocardiography, Recurrent aortic insufficiency

中图分类号:

R542.5

王晨琛, 方跃华, 施仲伟, 屈雪蒸. 25例主动脉瓣成形术后一年的超声心动图评价[J]. 诊断学理论与实践, 2022, 21(03): 395-398.

WANG Chenchen, FANG Yuehua, SHI Zhongwei, QU Xuezheng. Effect of surgical aortic valvuloplasty for aortic insufficiency using echocardiography one year after surgery in 25 patients[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 395-398.

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参考文献 16

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指标	患者（n=25）
男性（%）	18（72）
年龄（岁）	47.8±3.6
心率（次/分）	73.1±3.1
收缩压（mmHg）	133.0±3.6
舒张压（mmHg）	69.1±3.1
糖尿病（%）	2（8）
高血压（%）	15（60）
心房颤动（%）	0（0）
体质量指数（kg/m²）	23.0±0.7
体表面积（m²）	1.77±0.04

指标	手术前	手术后1年	t/z值	P值
心率（次/min）	73.1±3.1	78.6±2.0	1.756	0.092
左心房内径（mm）	34.8±3.2	37.6±4.9	-2.903	0.008
左心室舒张末期内径（mm）	54.4±4.6	50.0±4.9	5.036	<0.001
左心室收缩末期内径（mm）	34.0（31.0,38.0）	31.0（29.5,34.0）	-2.945	0.003
左心室舒张末期容积（mL）	145.7±28.8	120.4±27.8	4.856	<0.001
左心室收缩末期容积（mL）	47.0（37.5,63.0）	37.0（32.5,48.5）	-2.828	0.005
左心室每搏输出量（mL）	92.6±18.4	78.4±17.8	4.039	<0.001
左心室射血分数（%）	64.0（60.5,70.0）	65.0（63.5,68.0）	-0.404	0.686
肺动脉收缩压（mm Hg）	33.0（30.0,36.0）	31.0（29.5,33.3）	-0.832	0.405
E峰（cm/s）	69.8±21.6	66.6±10.4	1.047	0.314
A峰（cm/s）	57.3±13.2	66.1±17.3	-2.193	0.047
E/A	1.24±0.43	1.05±0.23	2.274	0.041
e'间隔侧（cm/s）	8.0±2.7	6.8±2.4	1.085	0.298
e'侧壁侧（cm/s）	11.9±4.7	12.6±3.1	-0.46	0.653
E/e'间隔侧	7.9（6.6,13.0）	10.9（8.6,12.0）	-0.879	0.379
E/e'侧壁侧	5.3（4.1,9.7）	6.5（5.0,7.8）	-0.722	0.470
E/e'平均值	6.4（5.4,11.6）	8.7（7.5,9.3）	0.157	0.875
主动脉瓣口流速（cm/s）	1.8±0.4	1.7±0.4	1.793	0.086
跨主动脉瓣压差（mmHg）	13.4±5.2	11.6±5.7	1.480	0.152

术前AI评分（分）	术后AI评分（分）	人数	χ²值	P值
0	0	1	21.000	0.021
1	0	1
1	2	1
2	0	1
2	1	1
3	0	2
3	1	4
3	2	1
4	0	3
4	1	2
4	2	3
4	3	4
4	4	1