超声心动图结合主动脉CTA评价马方综合征患者Bentall手术前后心血管系统功能  

Evaluation of Bentall operation and follow-up in patients with MFS by echocardiography combined with aortic CTA

作　　者：张火根 游宇光 廖园园 ZHANG Huo-gen;YOU Yu-guang;LIAO Yuan-yuan(Department of Ultrasound Medicine,The First Affiliated Hospital of Gannan Medical University,Ganzhou,Jiangxi 341000)

机构地区：[1]赣南医科大学第一附属医院超声医学科,江西赣州341000

出　　处：《赣南医学院学报》2024年第5期498-501,543,共5页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探讨马方综合征(Marfan syndrom,MFS)患者Bentall手术前后心血管系统的影像学表现。方法:选择2016年1月至2020年12月期间在本院行Bentall术治疗的10例MFS患者。术前及术后1周行计算机体层成像血管造影(Computed tomography angiography,CTA)检查及经胸彩色多普勒超声心动图检查,评估主动脉病变情况、心脏腔室大小、心功能指标及血流动力学等,并对患者进行最长达4年的随访。结果:10例行Bentall手术的患者中,术前CTA提示主动脉夹层Ⅰ型患者5例、主动脉夹层Ⅲ型患者3例,2例患者主动脉窦部或升主动脉明显扩张。术前超声心动图均可见主动脉瓣中度及以上反流,其中部分患者见左房和(或)左室增大,8例伴有轻度及以上二尖瓣反流,5例伴有三尖瓣反流;术后1周CTA与超声心动图均示主动脉区未见明显异常,左心室前后径与术前相比减小(P<0.05),左室射血分数(Left Ventricular Eject Fraction,LVEF)、左心室短轴缩短率(Left ventricular short-axis fractional shortening,LVFS)、每搏量(Stroke volume,SV)无明显差异(P>0.05);术后随访至今,5例出现心血管系统异常,1例因恶性心律失常而死亡,其余4例暂无不良心血管事件发生。结论:超声心动图结合主动脉CTA等影像学检查可用于MFS患者Bentall术前病情严重程度的评估以及术后治疗效果、随访预后等方面的监测。Objective:To study the imaging features of cardiovascular system before Bentall operation and the follow-up prognosis of patients with MFS.Methods:Ten MFS patients undergoing Bentall treatment in our hospital from January 2016 to December 2020 were selected.Aortic lesions and cardiac hemodynamics were observed before surgery,and the treatment effect of the aorta and the related changes in cardiac function indicators were observed one week after surgery,and the patients were also given follow-up for four years.Results:Among the 10 patients undergoing Bentall surgery,preoperative CTA suggested aortic dissection typeⅠ(5/10)and typeⅢ(3/10),and two patients had significant dilation of the aortic sinus or ascending aorta combined with severe aortic reflux.Moderate and above aortic regurgitation was seen in preoperative echocardiography,with some patients with left atrial and(or)left ventricular enlargement,eight with mild or above mitral regurgitation and five with tricuspid regurgitation.Both CTA and echocardiography one week later showed no significant abnormalities in the aortic area,left ventricle diameter decreased compared to preoperative diameter(P<0.05),there was no significant difference in LVEF,FS,and SV(P>0.05).Post-operative follow-up to this day,five cases developed cardiovascular system abnormalities,one case died due to a malignant arrhythmia,and the other four cases had no adverse cardiovascular events at present.Conclusion:Echocardiography combined with aortic CTA can be used to evaluate the severity of Bentall in patients with MFS before operation,monitor the postoperative treatment effect and follow-up prognosis.Conclusion:Echocardiography combined with aortic CTA can be used to evaluate the severity of Bentall in patients with MFS before operation,monitor the postoperative treatment effect and follow-up prognosis.

关 键 词：马方综合征 BENTALL手术 主动脉病变 计算机体层成像血管造影 超声心动描记术 多普勒 彩色 

分 类 号：R596.1[医药卫生—内科学] R445[医药卫生—临床医学]