三尖瓣环成形术后右心室收缩功能超声评价指标的探讨  

Tricuspid annular plane systolic excursion and tricuspid annular peak systolic velocity underestimate right ventricular systolic function after tricuspid annuloplasty

作　　者：马宁[1] 杨娅[1] 李治安[1] 孟旭[2] 张纯[1] 李宜嘉 张海波[2] 韩杰[2] 许春雷[2] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所超声科,北京100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,北京100029

出　　处：《心肺血管病杂志》2013年第6期750-753,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科委资助项目(Z111107067311038)

摘　　要：目的:研究三尖瓣环的收缩期位移(tricuspid annular plane systolic excursion,TAPSE)和收缩期峰值运动速度(tricuspid annular peak systolic velocity,TAPSV)指标能否准确评估三尖瓣环成形术(tricuspid valve plasty,TVP)后的右心室收缩功能。方法:选择左心瓣膜手术同时行TVP的患者45例。术前和术后测量右心室面积变化率(RVAC)、TAPSE及TAPSV等多项指标。术前、术后1w、术后3、6及12个月各复查经胸超声心动图一次。术前与术后指标做对比分析。结果:TAPSE术前(20.25±3.05)mm,术后1w、术后3、6及术后12个月分别为(8.68±2.83)mm,(9.13±3.12)mm,(9.20±2.46)mm,(9.29±2.58)mm,术前和术后差异有统计学意义(P<0.01)。TAPSV术前(17.8±4.00)cm/s,术后分别为(9.17±2.32)cm/s,(10.12±2.06)cm/s,(10.85±3.11)cm/s,(11.86±3.13)cm/s,术前和术后差异有统计学意义(P<0.01)。术前RVAC为(45.62±4.32)%,与术后(46.21±3.89)%,(48.45±4.02)%,(47.33±3.86)%及(47.92±4.33)%相比,差异无统计学意义(P>0.05)。术前及术后临床诊断均无右心功能不全。结论:TVP术后,经胸超声测量TAPSE、TAPSV低估了右心室收缩功能。在TVP术后不推荐使用其评价右心室收缩功能。Objective：Aims of this study were to evaluate if tricuspid annular plane systolic excursion （TAPSE） and tricuspid annular peak systolic velocity （TAPSV） indicators could accurately reflect the postop- erative right ventricular systolic function in patients after mitral valve or aotic valve surgery combined with tri- cuspid annuloplasty ring. Methods：45 patients were studied, who underwent left heart valve surgery combined with tricuspid annuloplasty ring. Transthoracic echocardiography were performed pre-surgery and lweek, 3, 6, and 12 months post-surgery. In addition to routine preoperative and postoperative transthoracic echocardiography parameters, also measured RVAC, TAPSE, TAPSV. Comparatively analysised preoperative and postoperative in- dicators. Results： TAPSE preoperative （ 20. 25 ±3.05 ） mm, postoperative （ 8.68 ± 2. 83 ） mm, （ 9. 13 ± 3.12 ） mm, （9. 20 ±2.46） ram, （9. 29 ±2. 58）mm at lweek, 3, 6, and 12 months respectively and TAPSV preopera- tive（17.8 ± 4 ） cm/s, postoperative （ 11.93 ± 2. 32 ） cm/s, （ 12. 12 ± 2. 06 ） cm/s, （ 12. 85 ± 3.11 ） cm/s, （ 12. 86 ± 3.13 ） cm/s at lweek, 3, 6, and 12 months respectively）. Postoperative values were significantly （P 〈 0. 01 ） lower after surgery in comparison with pre-surgical values. On the contrary, pre-operative RVAC（45.62 ± 4. 32） % did not change significantly after surgery （46. 21 ± 3.89 ） %, （48.45 ± 4. 02 ） %, （ 47. 33 ± 3.86） % and （47. 92 ± 4. 33 ）% at each step. Conclusion： Right ventricular function evaluation indicators TAPSE and TAPS underestimates right ventricular systolic function after after mitral valve or aotic valve sur- gery combined with tricuspid annuloplasty ring. So, TAPSE and TAPSV were not recommended to evaluate right ventricular systolic function after after tricuspid annuloplasty.

关 键 词：三尖瓣环成形 三尖瓣环位移 三尖瓣环运动速度 右心室功能 超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病]