[肺动脉高压时左右心室几何形态及血流动力学变化的可逆性。肺动脉血栓内膜剥脱术前及术后的超声心动图特征]
[Reversibility of changes in left and right ventricular geometry and hemodynamics in pulmonary hypertension. Echocardiographic characteristics before and after pulmonary thromboendarterectomy].
作者信息
Menzel T, Wagner S, Mohr-Kahaly S, Mayer E, Kramm T, Fischer T A, Bräuninger S, Meinert R, Oelert H, Meyer J
机构信息
II. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz.
出版信息
Z Kardiol. 1997 Nov;86(11):928-35. doi: 10.1007/s003920050133.
Pulmonary thromboendarterectomy (PTE) leads to an acute decrease of right ventricular (RV) afterload in patients with chronic thromboembolic pulmonary hypertension. We investigated the changes in right and left ventricular (LV) geometry and hemodynamics by means of transthoracic echocardiography. The prospective study was performed in 14 patients (8 female, 6 male; age 55 +/- 20 years) before and 18 +/- 12 days after PTE. Total pulmonary vascular resistance and systolic pulmonary artery pressure were significantly decreased (PVR: preoperative 986 +/- 318, postoperative 323 +/- 280 dyn x s/cm5, p < 0.05; PAP preoperative 71 +/- 40, postoperative 41 +/- 40 mm Hg + right atrial pressure, p < 0.05). End diastolic and end systolic RV area decreased from 33 +/- 12 to 23 +/- 8 cm2, respectively, from 26 +/- 10 to 16 +/- 6 cm2, p < 0.05. There was an increase in systolic RV fractional area change from 20 +/- 12 to 30 +/- 16%, p < 0.05. RV systolic pressure rise remained unchanged (516 +/- 166 vs. 556 +/- 128 mm Hg/sec). LV ejection fraction remained within normal ranges (64 +/- 16 vs. 62 +/- 12%). Echocardiographically determined cardiac index increased from 2.8 +/- 0.74 to 4.1 +/- 1.74 l/min/m2. A decrease in LV excentricity indices (end diastolic: 1.9 +/- 1 vs. 1.1 +/- 0.3, end systolic: 1.7 +/- 0.6 vs. 1.1 +/- 0.4, p < 0.05) proved a normalization of preoperatively altered septum motion. LV diastolic filling returned to normal limits: (E/A ratio: 0.62 +/- 0.34 vs. 1.3 +/- 0.8; p < 0.05); Peak E velocity: 0.51 +/- 0.34 vs. 0.88 +/- 0.28 m/sec, p < 0.05; Peak A velocity: 0.81 +/- 0.36 vs. 0.72 +/- 0.42 m/sec, ns; E deceleration velocity: 299 +/- 328 vs. 582 +/- 294 cm/sec2, p < 0.05; Isovolumic relaxation time: 134 +/- 40 vs. 83 +/- 38 m/sec, p < 0.05). We could show a marked decrease in RV afterload shortly after PTE with a profound recovery of right ventricular systolic function--even in case of severe pulmonary hypertension. A decrease in paradoxic motion of the interventricular septum and normalization of LV diastolic filling pattern resulted in a significant increase of cardiac index.
对于慢性血栓栓塞性肺动脉高压患者，肺动脉血栓内膜剥脱术（PTE）可导致右心室（RV）后负荷急性降低。我们通过经胸超声心动图研究了右心室和左心室（LV）几何形态及血流动力学的变化。这项前瞻性研究纳入了14例患者（8例女性，6例男性；年龄55±20岁），在PTE术前及术后18±12天进行评估。总肺血管阻力和收缩期肺动脉压显著降低（肺血管阻力：术前986±318，术后323±280达因×秒/厘米⁵，p<0.05；肺动脉压术前71±40，术后41±40毫米汞柱+右心房压，p<0.05）。舒张末期和收缩末期右心室面积分别从33±12平方厘米降至23±8平方厘米，从26±10平方厘米降至16±6平方厘米，p<0.05。右心室收缩期面积变化分数从20±12%增至30±16%，p<0.05。右心室收缩压上升保持不变（516±166与556±128毫米汞柱/秒）。左心室射血分数保持在正常范围内（64±16与62±12%）。超声心动图测定的心指数从2.8±0.74升/分钟/平方米增至4.1±1.74升/分钟/平方米。左心室偏心指数降低（舒张末期：1.9±1与1.1±0.3，收缩末期：1.7±0.6与1.1±0.4，p<0.05），证明术前改变的室间隔运动恢复正常。左心室舒张期充盈恢复至正常范围：（E/A比值：0.62±0.34与1.3±0.8；p<0.05）；E峰速度：0.51±0.34与0.88±0.28米/秒，p<0.05；A峰速度：0.81±0.36与0.72±0.42米/秒，无显著差异；E波减速速度：299±328与582±294厘米/秒²，p<0.05；等容舒张时间：134±40与83±38毫秒，p<0.05）。我们发现PTE术后不久右心室后负荷显著降低，右心室收缩功能明显恢复——即使在严重肺动脉高压的情况下也是如此。室间隔反常运动的减少和左心室舒张期充盈模式的正常化导致心指数显著增加。
Zotero 插件