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Effect of left ventricular preoperation regional function to clinical cardiac function class after mitral valve replacement
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- Author:
- No author available
- Journal Title:
- JOURNAL OF CHINESE PHYSICIAN
- Issue:
- 12
- DOI:
- 10.3760/cma.j.issn.1008-1372.2007.12.005
- Key Word:
- 心室功能障碍,左;风湿性心脏病;心脏瓣膜假体植入;超声心动描记术,多普勒
Abstract： 目的 探讨风湿性二尖瓣瓣膜置换术前左心室局部室壁功能异常对术后临床心功能分级的影响.方法 应用定量组织多普勒速度成像(QTVI)获取30例正常人和54例风湿性二尖瓣膜置换术(MVR)前后患者左室长轴方向不同室壁心肌多普勒速度曲线,分别比较手术前后不同室壁中部心肌运动收缩期峰值速度(Vs)、快速充盈期的速度(Ve),Vs/Ve比值,二尖瓣瓣膜置换术前后左室射血分数(LVEF),并对比分析这些术前参数的变化与术后临床心功能转归的关系.结果 (1)风湿性二尖瓣病变患者患者Vs、Ve均比正常人降低(P＜0.05);(2)手术前Vs、Ve、Vs/Ve明显减低患者,手术后NYHA分级、客观评分明显减低,手术前Vs、Ve、Vs/Ve无明显减低,患者手术后NYHA分级、客观评分较高;(3)若以手术前Vs/Ve＞0.75、LVEF＞45%作为判定患者二尖瓣瓣膜置换术后心功能符合临床NYHA分级Ⅰ～Ⅱ级、客观评分A～B级的界定值,其敏感性88%,特异性75%,阳性预测值86%.结论 MVR手术前左心室心尖区和前间壁的局部室壁运动功能异常与心瓣膜置换术后心功能后不全的发生密切有关,QTVI定量评价RM患者左室心肌功能,为进一步了解MVR局部心肌收缩舒张功能变化及其局部与整体心肌功能的变化提供较为敏感、精确的方法,对术后临床心功能分级的转归有一定预见性.
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