Jadhav Tejaswi, Kareem Hashir, Nayak Krishnananda, Pai Umesh, Devasia Tom, Padmakumar Ramachandran
Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Manipal, India.
Department of Cardiology, Kasturba Hospital, Kasturba Medical College, Manipal University, Manipal, India.
Interv Med Appl Sci. 2018 Sep;10(3):137-144. doi: 10.1556/1646.10.2018.31.
The aim of this study is to compare tricuspid annular plane systolic excursion (TAPSE) in pre- and postoperative valvular heart surgery patients using M-mode imaging, to determine changes in tissue Doppler parameters among patients undergoing valvular heart surgery, and to analyze tissue deformation parameters of right ventricle (RV) and RV strain in pre- and postoperative patients.
This was an observational, cross-sectional, single-center study that included 24 patients who underwent echocardiographic assessment prior to surgery, after surgery, and at 1-month follow-up. Assessment of left and right ventricles by M-mode echocardiography, evaluation of RV by 2D Doppler echocardiography, tissue Doppler imaging, and strain imaging were performed.
The TAPSE was significantly reduced immediately after surgery (14.8 ± 0.37 vs. 10.9 ± 0.26 mm), which was then improved on follow-up assessment (17.8 ± 34 mm) ( = 0.001). Tricuspid valve diastolic velocity was increased after surgery and then gradually declined at 1-month follow-up ( = 0.003). Presurgery RV free wall strain was found to be reduced, which was then improved during post-procedure analysis as well as on follow-up ( = 0.001).
After cardiac valvular surgery, RV myocardial deformation showed a gradual improvement after 1 month, although there was an immediate decline in RV function postsurgery. The pattern of RV contraction, as showed by RV strain, varied postsurgery, which was remarkably increased in postoperative patients at the time of follow-up. Tissue deformation imaging being an emerging technique helps in the assessment of minute, subtle changes that occur in the RV myocardial function in cardiac patients undergoing valve surgery.
本研究旨在使用M型成像比较心脏瓣膜手术患者术前和术后的三尖瓣环平面收缩期位移（TAPSE），确定心脏瓣膜手术患者组织多普勒参数的变化，并分析术前和术后患者右心室（RV）的组织变形参数和RV应变。
这是一项观察性、横断面、单中心研究，纳入了24例在手术前、手术后及1个月随访时接受超声心动图评估的患者。通过M型超声心动图评估左、右心室，采用二维多普勒超声心动图、组织多普勒成像和应变成像对RV进行评估。
术后即刻TAPSE显著降低（14.8±0.37对10.9±0.26mm），随后在随访评估中有所改善（17.8±34mm）（P = 0.001）。三尖瓣舒张期速度术后增加，然后在1个月随访时逐渐下降（P = 0.003）。术前发现RV游离壁应变降低，术后分析及随访期间有所改善（P = 0.001）。
心脏瓣膜手术后，尽管术后RV功能立即下降，但1个月后RV心肌变形逐渐改善。RV应变显示的RV收缩模式术后有所变化，随访时术后患者显著增加。组织变形成像作为一种新兴技术，有助于评估瓣膜手术心脏患者RV心肌功能发生的微小、细微变化。
