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目的:运用二维超声斑点追踪技术评价经皮室间隔封堵术前后患者心脏扭转运动的变化。方法:检测18例室间隔缺损患者封堵术前、术后第3天、术后1个月、术后3个月的常规心脏二维多普勒超声参数,并运用二维斑点追踪技术对患者的左心室旋转及扭转运动进行分析,以探讨室间隔缺损封堵术对其心脏扭转运动的影响。结果:封堵术后第3天,舒张期末左室内径(LVEDd)、左室舒张末容积(LVEDV)较术前减低较明显,左心室的基底部、心尖部的旋转角度及整体的扭转运动的角度较术前稍有减低。术后1个月、术后3个月,LVEDd、LVEDV较术前仍有降低,但降低的程度有减小的趋势;而左心室的基底部、心尖部的旋转角度及整体的扭转运动的角度仍有降低,降低的程度以术后1个月最明显,以后降低程度减小。患者封堵术前、术后第3天、术后1个月、术后3个月的LVEF稍有改变,但差异无统计学意义。无论是封堵术前、术后第3天、术后1个月、还是术后3个月,病人的左心室的基底部、心尖部的旋转角度峰值及整体的扭转运动的角度峰值均和LVEF呈线性相关,且以左室整体的扭转运动的角度峰值和LVEF的相关性最好。结论:经皮室间隔缺损封堵术通过逆转左室的重构而改善左室的扭转运动,且左室整体的扭转运动与LVEF的相关性最好。
OBJECTIVE: To evaluate the changes of cardiac torsion in patients before and after percutaneous transluminal septal occlusion using two-dimensional ultrasound speckle tracking. Methods: Two-dimensional Doppler echocardiography was performed in 18 patients with ventricular septal defect prior to occlusion, 3 days after surgery, 1 month after surgery, and 3 months after surgery. Two-dimensional speckle tracking Left ventricular rotation and torsion in patients with the analysis to explore the ventricular septal defect closure of the heart torsion exercise. Results: LVEDd and LVEDV decreased significantly at the end of diastole on the third day after closure. The basal and apical rotation angles of the left ventricle and the total torsion Slightly lower than the preoperative perspective. LVEDd and LVEDV were still lower than those before operation at 1 month and 3 months after operation, but the degree of decrease was decreased. However, the basal and apical rotation angles of the left ventricle and the overall torsional movement The angle is still lower, the degree of reduction in the most obvious after 1 month, reducing the degree of reduction later. The LVEF of patients before closure, 3 days after operation, 1 month after operation and 3 months after operation were slightly changed, but the difference was not statistically significant. Whether the closure of preoperative, postoperative 3 days, 1 month after surgery, or 3 months after surgery, the patient’s left ventricular base, apical angle of rotation peak and the overall peak twist angle LVEF was linearly correlated, and the correlation between peak LVEF and peak torsion of the whole LV was the best. CONCLUSION: Transverse ventricular septal defect occlusion improves left ventricular torsional motion by reversing left ventricular remodeling. The correlation between left ventricular total torsion and LVEF is the best.