二尖瓣及主动脉瓣置换术后患者远期的超声心动图特征及其临床意义  

Long-term Echocardiographic Outcomes of Patients after Mitral and Aortic Valve Replacement and Their Clinical Significance

作　　者：梁春水[1] 唐红[2] 任荣[1] 何帆[1] 邓云丹[1] 肖锡俊[1] 

机构地区：[1]四川大学华西医院心血管外科,成都610041 [2]四川大学华西医院心内科,成都610041

出　　处：《中国胸心血管外科临床杂志》2014年第3期336-343,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的了解二尖瓣和主动脉瓣置换术后患者远期的超声心动图特征，并探讨其临床意义。方法将1999年1月至2008年6月间四川大学华西医院施行的二尖瓣及主动脉瓣机械瓣双瓣膜置换术、且完成了术后≥5年超声心动图评价的204例患者纳入研究，其中男60例，女144例；年龄15～74（48．42±11．00）岁。术后随访时间5～13（6．34±2．05）年。观察所有患者术前、术后超声心动图指标，并进行比较。结果与术前相比，患者术后左心房径（LA）、左心室径（LV）明显缩小（P〈0．05），右心室径（RV）、左心室射血分数（LVEF）及左心室缩短分数（LVFS）增加（P〈0．05）。以二尖瓣狭窄为主的患者术后LA、LV、左心房面积（LAA）、左心房容积（LAV）、二尖瓣平均跨瓣压差（MPGmv）、二尖瓣速度时间积分（VTImv）及二尖瓣压力降半时间（PHTmv）均明显减小或降低（P〈0．05），而二尖瓣有效瓣口面积（EOAmv）、有效瓣口面积指数（EOAImv）明显增加（P〈0．05）；以二尖瓣反流为主的患者术后LA、LV明显缩小（P〈0．05）。以主动脉瓣狭窄为主的患者术后LV、室间隔厚度（IVS）、左心室质量（LVM）、左心室质量指数（LVMI）、主动脉瓣最大前向血流速度（Vav）及平均跨瓣压差（MPGav）均明显减小或降低（P〈0．05），主动脉瓣有效瓣口面积（EOAav）、有效瓣口面积指数（EOAIav）明显增加（P〈0．05），而左室后壁厚度（LVPW）变化不明显（P〉0．05）；以主动脉瓣反流为主的患者术后LV、LVM、LVMI、EOAav及EOAIav均明显减小（P〈0．05），而Vav、MPGav明显增加（P〈0．05）。在二尖瓣部位，与置入25mm瓣膜患者相比，置入27mm瓣膜患者Emv、MPGmv及VTImv均较低（P〈0．05）；在主动脉瓣部位，与置入21mm瓣膜患者相比，置入23mm瓣膜患者Vav、MPGav及VTIav均较低（P〈0．05）。术后远期二尖瓣部位Abstract： Objective To investigate long-term echocardiographic outcomes of patients after mitral and aortic valve replacement and their clinical significance. Methods A total of 204 patients who underwent mitral and aortic valve replacement from January 1999 to June 2008 in West China Hospital of Sichuan University, and had been followed up with echocardiography for longer than 5 years were enrolled in this study. There were 60 male and 144 female patients with their age ranging from 15 to 74 （48.42±11.00）years. Postoperative follow-up time was 5 to 13 （6.34±2.05 ）years. Preoperative and follow-up echocardiographic results were compared. Results Compared with preoperative results, postoperative left atrial diameter （ LA ） and left ventricular diameter （LV） significantly decreased （P 〈 0.05 ）, while right ventricular diameter （RV）, left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） significantly increased （P 〈 0.05 ）. Right atrial diameter （RA） did not change significantly （P 〉 0.05 ）. In the patients mainly with mitral stenosis preoperatively, postoperative LA, LV, left atrial area （LAA）, left atrial volume （LAV）, mitral mean pressure gradient （MPGmv）, velocity time integral （VTImv） and pressure half time （PHTmv） significantly decreased （P 〈 0.05 ）, while mitral effective orifice area （EOAmv） and effective orifice area index （EOAImv） increased significantly （P 〈 0.05 ）, but peak E velocity （Emv） did not change significantly （P 〉 0.05 ）. In the patients mainly with mitral regurgitation preoperatively, postoperative LA and LV decreased significantly （P 〈 0.05 ）, while LAA, LAV, MPGmv, VTImv, PHTmv, EOAmv and EOAImv did not change significantly （P 〉 0.05 ）. In the patients mainly with aortic stenosis preoperatively, postoperative LV, interventricular septal thickness （IVS）, left ventricular mass （LVM）, left ventricular mass index （LVMI）, aortic peak

关 键 词：双瓣膜置换术 术后随访 超声心动图 

分 类 号：R654.2[医药卫生—外科学]