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目的:探讨房间隔缺损(ASD)患者右室容量负荷增加及右室重构对左室心尖部、基底部的旋转运动的影响,并评价经皮房间隔缺损封堵术对左室旋转运动的急性期影响。方法:应用超声斑点追踪显像技术分别测量25例单纯房间隔缺损的患者术前及封堵术后3天的左室基底部及心尖部短轴6个节段的收缩期的旋转角度峰值及平均峰值,绘出左室基底部及心尖部短轴的平均旋角度—时间曲线;双平面Simpson法测左室射血分数(LVEF)。25例年龄性别匹配的正常人作为对照。结果:与对照组相比,ASD组术前基底部前间隔、侧壁、后壁、下壁、后间隔的顺时针旋转角度峰值减低(P<0.05),前壁的旋转角度峰值也减低,但差异无统计学意义。而术前左室心尖部短轴6个节段的收缩期的旋转角度峰值均较对照组降低,但是差异无统计学意义。而ASD组术后基底部前间隔、侧壁、后壁、下壁、后间隔的顺时针旋转角度峰值较术前升高(P<0.05),前壁的旋转角度峰值也升高,但差异无统计学意义。术后左室心尖部短轴6个节段的收缩期的旋转角度峰值较术前升高,但是差异无统计学意义。与正常对照组而言,ASD患者术后除侧壁仍较低外,其余各节段的旋转角度均接近正常对照组。结论:ASD引起的右室容量负荷增加及右室重构对左室基底部的旋转和左室整体扭转运动有影响,对心尖部的旋转运动的影响不明显。经皮房间隔缺损封堵术可以改善左室基底部的旋转因而也改善了左室整体扭转运动。
OBJECTIVE: To investigate the effect of right ventricular volume load and right ventricular remodeling on the rotational movement of the apex and basal part of left ventricular in patients with atrial septal defects (ASD). To evaluate the effects of percutaneous atrial septal defect occlusion on left ventricular rotational movement Acute phase effects. Methods: Ultrasound speckle tracking imaging was used to measure the peak systolic rotation angle of left ventricular base and 6 segments of apical short axis in 25 patients with atrial septal defect before operation and 3 days after occlusion respectively. Mean peak, draw the left ventricular base and apical short axis of the average angle of rotation - time curve; biplane Simpson method for measuring left ventricular ejection fraction (LVEF). Twenty-five age-matched normals served as controls. Results: Compared with the control group, the peak of clockwise rotation angle of anterior basal base, lateral wall, posterior wall, inferior wall and posterior septum in ASD group decreased (P <0.05), and the peak value of anterior wall rotation angle decreased, But the difference was not statistically significant. Preoperative left ventricular apical short axis 6 segments systolic rotation angle peak compared with the control group decreased, but the difference was not statistically significant. However, the peak of clockwise rotation angle of basilar anterior septum, lateral wall, posterior wall, inferior wall and posterior septum in ASD group was higher than that before operation (P <0.05), and the peak value of anterior wall rotation angle was also increased, but the difference No statistical significance. Postoperative left ventricular apical short axis 6 segments systolic rotation angle peak compared with preoperative, but the difference was not statistically significant. Compared with the normal control group, the rotation angles of the other segments were all close to those of the normal control group except for the low side wall of the ASD patients. CONCLUSIONS: The increase of right ventricular volume load and right ventricular remodeling caused by ASD has an effect on the rotation of left ventricular base and left ventricular total torsion, but has no obvious effect on the apex rotational movement. Transcatheter closure of atrial septal defects can improve the left ventricular base of the rotation and thus improve the overall left ventricular torsion.