外科心脏再同步化治疗的超声心动图评价  

A Short-term Follow-up Study of Surgical Cardiac Resynchronization Therapy

作　　者：李治安[1] 张烨[1] 何怡华[1] 杨娅[1] 张海波[2] 孟旭[2] 

机构地区：[1]北京安贞医院超声科,北京市100029 [2]北京安贞医院心脏外科,北京市100029

出　　处：《中国超声医学杂志》2010年第3期244-247,共4页Chinese Journal of Ultrasound in Medicine

基　　金：国家教育部高等学校博士点科研基金(No.20060025001)资助

摘　　要：目的应用超声心动图来评价外科方法植入左室心外膜电极的心脏再同步化治疗(CRT)慢性心力衰竭的可行性和近期疗效。方法接受外科CRT的慢性心力衰竭患者10例,用常规超声心动图及组织多普勒成像技术观察术前、术后左室收缩功能指标和心脏同步性参数的变化,并且在术中应用经食管超声心动图(TEE)指导左室心外膜电极位置的优选。结果与术前比较,CRT术后的左室舒张末期内径(LVEDD)由(69.4±13.6)mm降至(60.0±6.9)mm(P<0.05)。左室射血分数(LVEF)由(32.9±7.6)%升至(41.3±8.3)%(P<0.05),左室不同步指数12-Tp-SD由(143.2±30.8)ms降至(56.4±22.1)ms(P<0.05)。结论外科指导植入左室心外膜电极的CRT是安全的,有效的。传统超声心动图及组织同步显像技术能够指导左室心外膜电极放置于真正的靶位置,并评价其疗效。Objective To evaluate the clinical value of echocardiography guided left ventricular （LV） epicardial lead placement for surgical cardiac resynchronization therapy （CRT） . Methods From April 2007 to December 2008, 10 patients （male 6, 59±8.6 year） with New York Heart Association （NYHA） ClassⅢ-Ⅳ symptoms, LV ejection fraction 32.9±7.6% and LV systolic dyssynchrony underwent LV epicardia[ lead placements via surgical approach. Echocardiography and Tissue Doppler imaging （TDI） was used to assess changes in LV function and dyssynchronic parameters. Also, intraoperative transesophageal echocardiography was used to select the best site for LV epicardial lead placement. Results LV epicardial lead was successfully implanted in the posterior or lateral position without serious complications. All patients reported symptomatic benefit with reduction in New York Heart Association score from Ⅲ-Ⅳ preoperatively to Ⅱ-Ⅲ postoperatively. Comparing with baseline, post CRT for 10 HF patients, LV end-diastolic diameter （LVEDD） decreased from 69.4±13.6 mm to 60.0±6.9 mm （P〈 0.05）, and LV ejection fraction （EF） increased from 32.9±7.60% to 41.3±8.3% （P% 0.05） . LV intraventricular dyssynchrony index decreased from 143.2± 30.8 ms to 56.4±22.1 ms （P〈0.05） . Conclusions Minimally invasive surgical placement of the LV epicardial lead is feasible, safe, and efficacious. TDI can guide the epicardial lead placement to the ideal target location.

关 键 词：超声心动图 心脏再同步化治疗 左室心外膜电极 

分 类 号：R654.2[医药卫生—外科学]