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目的:运用二维超声斑点追踪技术评价经皮房间隔封堵术前后患者右心室运动速度、应变及应变率的急性期变化。方法:检测25例房间隔缺损患者封堵术前、术后第3天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右心室运动速度、应变及应变率进行分析,以探讨房间隔缺损封堵术对右心室运动的影响。25例年龄性别匹配的正常人作为对照。结果:房间隔缺损患者术前的右心室游离壁的运动速度较正常对照显著加快(P<0.05),而封堵术后出现了明显的下降并且接近正常对照的运动速度(P>0.05)。在房间隔缺损封堵术前,右心室游离壁的应变较正常对照升高(P<0.05),右心室游离壁的应变率较正常对照升高但是差异无统计学意义(P>0.05)。封堵术后,右心室游离壁的峰值应变及应变率出现下降趋势,但是较术前而言差异不显著(P>0.05)。较正常对照而言,房间隔缺损患者术前室间隔的运动速度及峰值应变显著升高(P<0.05),并且在术后出现显著的降低(P<0.05)。而室间隔部位的应变率则未发现类似变化,无论和正常对照比较还是和术前比较,均未发现明显变化(P>0.05)。结论:经皮室间隔缺损封堵术通过迅速减轻右心室的容量负荷而影响右心室的运动速度、应变及应变率。其中右心室的形变参数对右心室容量负荷的急性变化不敏感,而右心室的运动速度受负荷改变的影响明显。
OBJECTIVE: To evaluate the acute phase changes of right ventricular motion velocity, strain and strain rate before and after transcatheter closure of atrial septal defects using two-dimensional ultrasound speckle tracking technique. Methods: Two-dimensional Doppler echocardiography was performed on 25 patients with atrial septal defect before and after operation, and the right ventricular motion velocity, strain and strain rate were measured by 2D speckle tracking Analysis to explore the impact of atrial septal defect occlusion on right ventricular motion. Twenty-five age-matched normals served as controls. Results: The velocity of right ventricular free wall in patients with atrial septal defect before operation was significantly higher than that of the normal control group (P <0.05). However, the velocity of the right ventricular free wall after the occlusion was significantly lower than that of the normal control (P> 0.05). Before occlusion of atrial septal defect, the strain of the free wall in the right ventricle was higher than that of the normal control (P <0.05). The strain rate of the free wall in the right ventricle was higher than that of the normal control, but the difference was not statistically significant (P> 0.05). After closure, the peak strain and strain rate of the free wall in the right ventricle decreased, but the difference was not significant (P> 0.05). Compared with normal control, the velocity and peak strain of preoperative interventricular septum significantly increased in patients with atrial septal defect (P <0.05), and significantly decreased after surgery (P <0.05). However, no similar changes were found in the strain rate at the septal site. No significant changes were observed in the strain rate of the interventricular septum compared with the normal control group or before surgery (P> 0.05). CONCLUSION: Percutaneous transcatheter closure of ventricular septal defect affects right ventricular velocity, strain and strain rate by rapidly reducing the capacity load of the right ventricle. Right ventricular deformation parameters of right ventricular volume load is not sensitive to acute changes, while the right ventricular velocity is affected by changes in load significantly.