磁共振评估室壁瘤患者手术后室壁应力及收缩功能的变化  

Effects of left ventricular reconstruction on magnetic resonance imaging derived left ventricular wall stress and contractive function in patients with postinfarction ventricular aneurysm

作　　者：樊红光[1] 凤玮[1] 郑哲[1] 张岩[2] 赵世华[2] 胡盛寿[1] 

机构地区：[1]北京协和医学院 中国医学科学院 阜外心血管病医院 卫生部心血管疾病再生医学重点实验室外科,100037 [2]北京协和医学院 中国医学科学院 阜外心血管病医院 卫生部心血管疾病再生医学重点实验室放射科,100037

出　　处：《中华心血管病杂志》2010年第2期108-111,共4页Chinese Journal of Cardiology

基　　金：国家科技支撑计划项目（2006BAI01A09）;北京市科技计划项目（D0906004040391）

摘　　要：目的研究左心室成形术对心肌梗死后室壁瘤患者左心室应力及收缩功能的影响。方法以2005年1月至2006年6月间16例因心肌梗死后室壁瘤在我院行外科手术的患者为研究对象，其中男15例，女1例，年龄38～68（56．6±8．8）岁。所有患者手术前行磁共振（MRI）检查，用Seimens Magnetom Avanto 1．5 TMR常规扫描、长轴和短轴电影及延迟增强序列扫描。术前明确诊断为前壁心尖部室壁瘤。所有患者均在全身麻醉低温体外循环下施行手术，其中线性缝合术5例，心内膜环缩成形6例，左心室内补片成形5例。15例同期行冠状动脉旁路移植术。术后3个月内按相同序列复查MRI。用成像仪的自动图像分析系统进行左室几何形态参数测量及节段性心功能测量，根据MRI相关数据结合测量袖带血压计算室壁应力。根据术前冠状动脉造影检查结果与术中再血管化情况对比确定相应再血管化及未再血管化的节段。用配对t检验比较手术前后节段性室壁应力和室壁增厚率的变化。结果MRI检查均顺利完成并获得了具有诊断价值的图像。选取基底水平及乳头肌水平两个切面用六分法分节段，16个病例共192个节段，其中未再血管化节段74个。与术前相比，未再管化的节段术后节段性室壁增厚率增强，室壁应力下降，且室壁增厚率的增强与应力下降呈正相关。结论左心室成形术可以降低心肌梗死后室壁瘤患者的左心室壁应力，并改善心肌收缩功能。Objective To evaluate the effects of left ventricular reconstruction on left ventricular wall stress and function in patients with postinfarction left ventricular aneurysm. Methods During January 2005 to June 2006, 16 patients [ 15 male, （56. 6 ± 8.8） years] with postinfarction ventricular aneurysm received left ventricular reconstruction operation on CPB （5 linear repair, 6 endoventricular purse-string suture, 5 endoventricular patch repair） and CABG was also performed in 15 patients. MRI examination was made before and 3 months post operation by Siemens Magnetom Avanto 1.5T MR with routine cine-MRI in combination with late-delayed enhancement sequence. Left ventricular geometric parameters and segmental thickening were obtained with accessory image analysis software. Non-invasive blood pressure was acquired in order to compute ventricular wall stress. The revascularized and unrevascularized segments were defined by comparing the post operation revascularization of the blood-supply coronary artery with preoperative results. Results A total of 192 segments including 74 unrevascularized segments were analyzed. Segmental thickening were significantly increased while wall stress were significantly reduced in both unrevascularized and revascularized segments 3 months post operation compared to preoperative values （ all P 〈 0. 05 ）. The increase of wall thickening was positively correlated with the reduction of wall stress in these segments. Conclusion Left ventricular reconstruction plus CABG is associated with reduced left ventricular wall stress and increased myocardial contractive function in patients with postinfarction left ventricular aneurysm.

关 键 词：磁共振成像 心脏室壁瘤 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]