经食管全方向M型超声心动图在二尖瓣置换术中评价三尖瓣环功能  

Evaluation on the function of tricuspid annulus by transesophageal omni-directional M-mode echocardiographyin patients during mitral valve replacement

作　　者：郭薇[1] 昊丽珊 

机构地区：[1]福建省立医院超声科,福州350001

出　　处：《中华超声影像学杂志》2017年第11期953-957,共5页Chinese Journal of Ultrasonography

基　　金：福建省卫生厅创新课题（2011-CX-2）

摘　　要：目的应用经食管全方向M型超声心动图（omni—directionalM—modeechocardioraphy，OME）在二尖瓣置换术中评价三尖瓣环功能，为同期行三尖瓣成形术提供参考。方法选取经食管超声心动图检查未见异常的正常人25例作为对照组。二尖瓣狭窄患者33例作为病变组，其中l一尖瓣成形组（tricuspidvalvuloplastygroup，TVP组）17例，非三尖瓣成形组（non-tricuspidvalvuloplastygroup，NTVP组）16例，分别于术前、术后经食管二维超声测量右室面积变化率（rightventricularfractionalareachange，RVFAC）、三尖瓣环最大径（maximaltricuspidannulardiameter，TADmax）并计算三尖瓣环缩短分数（tricuspidannularfractionalshortening，TAFS），彩色多普勒评估三尖瓣反流程度，通过OME及定量组织速度成像技术测量j三尖瓣环收缩期峰值速度。结果术后TVP组TADmax测值较术前减小（P〈0．05），三尖瓣反流程度较术前明显改善（P〈0．05）。病变组的术前三尖瓣环收缩期峰值速度与TADmax／BSA大小呈负相关（r=-0．53，P〈0．01），与TAFS呈正相关（r=0．68，P〈0．01），与RVFAC呈正相关（r=0，87，P〈0．01）。结论OME测量的三尖瓣环收缩期峰值速度有助于评估三尖瓣环功能，为手术方案选择提供有价值的参考。Objective To evaluate the function of tricuspid annulus using omni directional M-mode echocardioraphy（OME） in patients during mitral valve replacement（MVR）, and provide a reference for clinical decision about concomitant tricuspid annuloplasty for patients under MVR. Methods Twenty five normal subjects were selected as control group. Thirty-three patients under MVR for mitral stenosis were divided into tricuspid annuloplasty group（TVP group, n = 17） and non-tricuspid annuloplasty group（NTVP group, n = 16）. Transesophageal echocardiography （TEE） was performed before and after surgery. The right ventricular fractional area change（RVFAC）, maximal tricuspid annular diameter（TADmax）, tricuspid annular fractional shortening（TAFS） and tricuspid regurgitation（TR） degree were detected by 2D and color Doppler echocardiography. OME and quantitative tissue velocity imaging（QTVI） were used to measure the peak systolic velocity of tricuspid annular, which were defined as Sm and St. Results In the TVP group, TADmax decreased and TR degree improved significantly compared with preoperative date （P〈0.05）. Preoperative Sm had nagative correlation with TADmax/BSA （ r = - 0.53, P 〈0.111 ） and RVFAC（ r = 0.87, P 〈0.01）, and positive correlation with TAFS （r = 0.68, P 〈0.01 ）. Conclusions The peak systolic velocity of tricuspid annulus measured by OME can assess the function of tricuspid annulus additionally, and provide a reference for clinical decision about concomitant tricuspid annuloplasty for patients under MVR.

关 键 词：超声心动描记术 经食管 二尖瓣置换术 三尖瓣成形术 三尖瓣环收缩期峰值速度 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]