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目的探讨组织多普勒成像(TDI)评价风湿性心脏病单纯性二尖瓣狭窄(MS)患者经皮球囊扩张术(PBMV)前后心房内和心房间电机械延迟的价值。方法采用TDI测量30例对照组和30例MS合并窦性心律患者(PBMV术前、后)P波起始点至心尖四腔观左室侧壁、室间隔侧二尖瓣环及右室侧壁三尖瓣环组织多普勒曲线上A波起始点的时限(P-LA、P-IAS、P-RA),计算左房内、右房内及左右心房间电机械延迟(T1、T2、T3),即P-LA与P-IAS、P-IAS与P-RA、P-LA与P-RA差值;分析MS患者这些指标变化值与左房容积指数(LAVI)、左房内径指数(LADI)、二尖瓣口面积(MVA)、平均二尖瓣跨瓣压差(MMG)变化值的相关性。结果 MS患者P-LA、P-IAS较对照组明显延长(P<0.05),PBMV术后明显缩短(P<0.05);T1、T2、T3较对照组明显增大(P<0.05),PBMV术后明显减少(P<0.05)。P-LA、P-IAS及T1、T3变化值与LAVI变化值呈显著相关(P<0.05),而与LADI、MVA、MMG变化值无明显相关关系(P>0.05)。结论 TDI可准确评价MS患者心房内和心房间电机械延迟;PBMV术后MS患者电机械活动的改善与左房容积缩小关系密切。
Objective To investigate the value of tissue Doppler imaging (TDI) in the evaluation of mechanical atrial and atrial electrical delay before and after percutaneous balloon dilatation (PBMV) in patients with rheumatic heart disease (SAP) with simple mitral stenosis. Methods TDI was used to measure the origin of P wave in the 30 patients with sinus rhythm (30 preoperative and postoperative PBM) and 30 patients with MS complicated with sinus rhythm (left ventricular wall, left ventricular wall of mitral annulus and right ventricular wall Tricuspid annulus tissue Doppler curve on the A wave starting point of time (P-LA, P-IAS, P-RA), left atrial, right atrial and left atrial electrical mechanical delay (T1, T2, T3, P-LA, P-IAS, P-IAS and P-RA, P-LA and P-RA. The changes of these indexes in patients with MS were compared with left atrial volume index (LAVI) (LADI), mitral valve area (MVA) and mean mitral valve pressure (MMG). Results Compared with control group, the levels of P-LA and P-IAS in MS patients were significantly longer (P <0.05), and PBMV significantly shorter after operation (P <0.05) Postoperatively decreased significantly (P <0.05). The changes of P-LA, P-IAS and T1, T3 were significantly correlated with LAVI (P <0.05), but not with LADI, MVA and MMG (P> 0.05). Conclusion TDI can accurately evaluate the atrial and atrial electrical mechanical delay in patients with MS. The improvement of electromechanical activity in patients with MS after PBMV is closely related to the reduction of left atrial volume.