超声心动图对Ebstein畸形解剖矫治术近期疗效的评价  

Echocardiographic evaluation of the early results of anatomic correction of Ebstien′s anomaly

作　　者：吕秀章[1] 刘延玲[1] 吴清玉[2] 黄志雄[2] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院超声科,北京100037 [2]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院外科,北京100037

出　　处：《中华超声影像学杂志》2001年第9期523-525,共3页Chinese Journal of Ultrasonography

摘　　要：目的　探讨超声心动图诊断Ebstein畸形的准确性及其对解剖矫治术的近期疗效评价。方法　 16例行Ebstein畸形解剖矫治术的患者 ,术前超声心动图评价三尖瓣下移的程度、三尖瓣瓣叶及瓣下腱索发育情况、房化右室的大小、三尖瓣反流的程度 ,并与术中发现比较。所有患者术后均随访超声心动图 ,与术前结果进行比较分析。结果　 16例患者中 ,超声心动图检查三尖瓣前叶均无下移 ,但发育冗长 ,瓣叶运动异常。隔叶及后叶均下移 ,其瓣叶及瓣下结构发育异常。房化右室的大小为 2 .0cm× 3 .5cm至 6 .0cm× 8.0cm。所有病例均有右房扩大、三尖瓣瓣环扩张及三尖瓣反流 ,其中 8例中度反流 ,8例重度反流。术中发现 2例三尖瓣前叶的后1/4下移 (分别为 8mm和 11mm) ,2例后叶呈螺旋样下移 ,其余与术前超声心动图检查结果相同。术后 1～ 17个月 (平均 7个月 )随访 ,超声心动图显示右房明显缩小 ,房化右室消失 ,三尖瓣叶均在正常瓣环水平 ,重建的瓣膜均存活、启闭正常。 13例三尖瓣反流消失 ,1例轻度反流 ,2例残余中度反流。Objective To evaluate the accuracy of echocardiography in diagnosing Ebstien′s anomaly and the results of anatomic correction of Ebstien′s anomaly.Methods Sixteen consecutive patients underwent anatomic correction of Ebstien′s anomaly.The extent of inferior displacement of the proximal attachments,the abnormalities of the distal attachments of tricuspid valve leaflets,the size of atrialized right ventricle,and tricuspid regurgitation were evaluated by pre surgery echocardiography.All data were compared with the findings during surgery.All patients have been followed up by echocardiography.Results All anterior leaflets had the normal hinge points,but were redundant with abnormal movement.The downward displacement of the hinge points involved all the septal and posterior leaflets.The proximal and distal attachments of the septal and posterior leaflets had dysplasia.The size of atrialized right ventricle was 2.0 cm× 3.5 cm to 6.0 cm× 8.0 cm.The right atrium and the annulus of tricuspid enlarged in all patients.All patients had tricuspid regurgitation (8 moderate,8 severe).The findings in surgery were the same as the pre operation echocardiographic results except for the partial downward displacement of anterior leaflets in 2 patients.During the follow up(1～17 months,mean 7 months),the echocardiography showed the regurgitation of tricuspid disappeared in 13 patients,which were mild in one patient and moderate in 2 patients.The tricuspid valve leaflets were at the normal level,right atrium decreased in size remarkably and atrialized right ventricle vanished.Conclusions Echocardiography can accurately evaluate the abnormalities of proximal and distal attachments of tricuspid valve leaflets of Ebstien′s anomaly and show the results of anatomic correction of Ebstien′s anomaly.

关 键 词：超声心动描记术 爱泼斯坦异常 治疗 三尖瓣 

分 类 号：R540.45[医药卫生—心血管疾病]