环肺静脉电隔离术后阵发性房颤患者左心耳结构及功能的超声评价  

Evaluation of Left Atrial Appendage Structure and Function in Patients with Paroxysmal Atrial Fibrillation Underwent Circumferential Pulmonary Vein Ablation using Transesophageal Echocardiography

作　　者：李伟[1] 张棣[1] 郭盛兰[1] 刘浩[2] 覃诗耘[1] 王强[2] 秦续潭 

机构地区：[1]广西医科大学第一附属医院超声科,南宁市530021 [2]广西医科大学第一附属医院心内科,南宁市530021

出　　处：《中国超声医学杂志》2016年第3期227-230,共4页Chinese Journal of Ultrasound in Medicine

基　　金：广西医疗卫生重点科研课题(No.桂卫重200923)

摘　　要：目的应用经食管超声心动图（TEE）评价阵发性房颤患者行环肺静脉电隔离术（CPVA）后左心耳（LAA）结构和功能的变化。方法对43例首次行CPVA术的阵发性房颤患者,留取CPVA术前1周内及术后24-48h、3个月常规经胸及经食管超声图像进行分析,经胸测量左心房前后径、左右径及上下径（LADap、LADml、LADsi）;经食管测量左心耳最大峰值排空速度（LAA-PEV）、最大峰值充盈速度（LAA-PFV）、左上肺静脉界脊宽度（LAA-RW）;描记左心耳舒张末期面积（LAA-EDA）、收缩末期面积（LAA-ESA）,并计算左心耳射血分数（LAA-EF）;记录左心耳自发性超声显影（LAA-SEC）现象。结果与术前相比,术后24-48hLAA-EF有减小的趋势,但差异无统计学意义（P〉0.05）;术后3个月LAA-EF明显增加（P〈0.05）。与术前相比,术后24-48hLAA-RW明显增加（P〈0.05）。43例患者中,术前左心耳自发性超声显影（LAA-SEC）3例（6.98%）;术后24-48hLAA-SEC 5例（11.63%）;术后3个月LAA-SEC 1例（2.33%）。结论 CPVA术后阵发性房颤患者左心耳收缩功能逐渐得到改善。CPVA术短期内对左心耳、肺静脉界脊造成一定损伤。TEE可作为评价CPVA术后左心耳结构和功能的一种准确、有效的检查方法。Objective To evaluate the change of left atrial appendage（LAA）structure and function in patients with paroxysmal atrial fibrillation（PAF）after circumferential pulmonary vein ablation（CPVA）using transesophageal echocardiography（TEE）.Methods 43 PAF patients underwent CPVA were included.TTE and TEE images of 1week before and 24-48 hours,3months after CPVA were stored for analysis.A range of left atrial,LAA and left atrial appendage ridge structural and functional parameters were measured,including LA anteroposterior diameter（LADap）,LA mediolateral diameter（LADml）and LA superior-infra diameter（LADsi）by TTE;left atrial appendage peak emptying velocity（LAA-PEV）,LAA-filling velocity（LAA-PFV）,left atrial appendage ridge width（LAA-RW）,left atrial appendage end-diastolic area（LAA-EDA）,LAA-end-systole area（LAA-ESA）,left atrial appendage ejection fraction（LAA-EF）,left atrial appendage spontaneous echo contras（LAA-SEC）by TEE.Results Between 24-48 hours,LAA-EF decreased temporarily;but no statistical differences existed（P〈0.05）.3months of follow up,LAA-EF increased significantly（P〈0.05）.After 24-48hours、3 months,LAA-PEV,LAA-PFV increased,but no statistical differences existed（P〈0.05）.Between 24-48 hours,LAA-RW increased significantly（P〈0.05）;but no statistical differences existed between before CPVA and 3 months（P〈0.05）.In 43 cases patients with TEE：Before CPVA,LAA-SEC were found in 3cases（6.98%）;Between 24-48 hours,LAA-SEC were found in 5cases（11.63%）;3months after CPVA,LAA-SEC were found in 1case（2.33%）.Conclusions LAA structure and function were significantly increased after CPVA.CPVA can lead to significant damage to LAA in a short time.TEE is an accurate and effective way to evaluate the change of LAA after CPVA.

关 键 词：经食管超声心动图 心房颤动 环肺静脉电隔离术 左心耳 

分 类 号：R541.75[医药卫生—心血管疾病]