叶富永，梁均强，林晓春，赖东霞



探讨三维超声心动图评价房间隔缺损封堵术后右心房功能的价值

叶富永，梁均强，林晓春，赖东霞

摘要

关键词超声心动描计术，三维；心房功能，右；房间隔缺损

作者单位：525200 广东省，高州市人民医院 超声科

Effect of Three-dimensional Echocardiography for Evaluating Right Atrial Function in Patients After Atria Sepal Defect Closure

YE Fu-yong,LIANG Jun-qiang,LIN Xiao-chun,LAI Dong-xia.
Department of Ultrasound,Gaozhou People’s Hospital,Gaozhou(525200),Guangdong,China
Corresponding Author:YE Fu-yong,Email:drleaf@sina.com

Abstract

Objective:To explore the effect of three-dimensional echocardiography(RT-3DE)for evaluating right atrial function in patients after atrial septal defect(ASD)closure.

Methods:Our research included 2 group:ASD group,n=50 patients with successful ASD closure and Control group,n=30 normal subjects from physical examination.RT-3DE was conducted at pre-operation and at 3 days,1 month,3 months post-operation;the volume of right atrium before contraction(Vpre),minimum volume of the right atrium(Vmin),maximum volume of the right atrium(Vmax),total emptying volume of right atrium(Vt),total emptying volume fraction of right atrium(Ft),active emptying volume fraction(Fa)and passive emptying volume fraction(Fp)were measured and compared between 2 groups at pre- and post-operation respectively.

Results:At pre-operation,compared with Control group,ASD group had increased Vmax,Vmin,Vpre,Vt,and Fa,while decreased Ft and Fp,all P<0.05.At 3 days post-operation,compared with Control group,ASD group had increased Vmax,Vmin,Vpre,Vt,and Fa,while decreased Ft and Fp,all P<0.05.Compared with pre-operation,ASD group had decreased postoperative Vmax,Vmin,Vpre,Vt and Fa while increased Ft and Fp at 3 time points,all P<0.05.At 3 months post-operation,theabove 7 indexes were similar between ADS group and Control group,P>0.05.

Conclusion:ADS patients had abnormal volume and function in right atrium,the abnormalities could be improved at 3 days after ASD closure and could be recovered to normal level at 3 months after operation.RT-3DE has the important role for evaluating right atrial volume and function in patients after ASD closure.

Key words Echocardiography,three-dimensional;Atrial function,right;Heart septal defect

(Chinese Circulation Journal,2016,31:276.)

房间隔缺损（atrial septal defect，ASD）是先天性心脏病（先心病）的一种，占成人先心病的40%，儿童先心病的10%。ASD由于房水平左向右分流导致右心房容量负荷加重，引起右心房扩张。介入封堵术是继发孔型ASD的首选治疗方法，封堵器阻断房水平分流后，右心房形态及功能可在一定程度上得到恢复[1,2]。本研究应用实时三维超声心动图（real-time three-dimensional echocardiography，RT-3DE）检测ASD封堵术前、后右心房功能的各项指标，探讨RT-3DE评估ASD封堵术后右心房功能变化的价值。

1　资料与方法

研究对象：纳入我院2012-09至2015-04期间继发孔型ASD患者50例为房间隔缺损（ASD）组，其中男性13例，女性37例，年龄16～75岁，平均年龄（38.82±15.61）岁，50例均成功接受介入封堵术，全部病例分别于术后第3天、1个月、3个月接受超声心动图检查。30例体检正常者为正常组，男性14例，女性16例，年龄16～67岁，平均年龄（40.03±14.36）岁，经查体、实验室检查、心电图、超声心动图检查排除其他心脏疾患。

方法与图像处理：采用Philips iE33超声诊断仪（飞利浦，美国），配备S5-1探头，频率1～5 MHz，X3-1全容积探头，频率1～3 MHz，Qlab8.0软件分析系统。患者取左侧卧位，连接心电图导联，行常规二维超声心动图检查后，切换用X3-1实时三维超声探头，于心尖处得到清晰的心尖四腔心切面后，启动“全容积”显示方式，采集全容积图像后，打开Qlab8.0的3DQ Advance定量分析功能，将右心房置于平面正中，参考左心室功能分析方法，分别于心尖四腔、两腔切面三尖瓣环处及心房顶部描记五点进行心内膜自动勾画，必要时应用“Add Ref.Points”进行细微调整，将封堵器排除在容积之外。……