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目的 :探讨风湿性心脏病 (风心病 )二尖瓣病变并发右心室收缩功能减低患者冠状静脉窦 (CS)解剖结构改变及其影响因素。方法 :风心病组和对照组各 2 8例 ,采用经胸超声心动图技术 ,测量冠状静脉窦口 (CSO)和冠状静脉窦中部 (CSM)内径、左右心房内径、左右心室射血分数等指标 ,估测三尖瓣反流程度。结果 :与对照组比较 ,风心病组CSO和CSM明显增宽〔(8.2 5± 1.6 2 )mm∶(12 .93± 3.0 1)mm ,P <0 .0 0 1;(6 .75± 1.4 6 )mm∶(10 .79± 2 .90 )mm ,P <0 .0 0 1〕 ;CSO和CSM与右心房内径正相关 (r =0 .82 ,P <0 .0 0 1;r =0 .84 ,P <0 .0 0 1) ;CSO在重度三尖瓣反流组明显大于轻、中度反流组〔(15 .5± 2 .98)mm∶(11.9± 2 .38)mm ,P <0 .0 0 1〕。结论 :风心病二尖瓣病变并发右心室收缩功能减低患者CS增宽 ,扩张程度与右心房内径和三尖瓣反流程度相关 ,提示右心房压力和容量负荷增重是本组患者CS扩张的原因。
Objective: To investigate the anatomic changes of coronary sinus (CS) and its influencing factors in patients with rheumatic heart disease (rheumatic heart disease) with mitral valve disease and right ventricular systolic dysfunction. Methods: Eighteen cases of rheumatic heart disease (DCM) and control group were enrolled in this study. The transthoracic echocardiography was used to measure the diameter of the coronary sinus ostium (CSO) and the middle part of the coronary sinus (CSM), the left and right atrial diameters, left and right ventricular ejection fraction , Estimated tricuspid regurgitation degree. Results: Compared with the control group, the CSO and CSM in patients with rheumatic heart disease were significantly increased (8.2 5 ± 1.6 2) mm: (12.93 ± 3.01) mm, P <0.01; (6.75 ± 1.4 6) mm: (10.79 ± 2.90) mm, P <0.001). CSO and CSM were positively correlated with the right atrium diameter (r = 0.82, P < 0.84, P <0.01). CSO was significantly higher in patients with severe tricuspid regurgitation than those with mild or moderate reflux [(15.5 ± 2.98) mm: (11.9 ± 2.38) mm, P <0 0 1 0]. CONCLUSIONS: The CS of patients with rheumatic mitral valve disease complicated by right ventricular systolic function is widened. The degree of dilatation is related to the right atrial diameter and the degree of tricuspid regurgitation. It is suggested that the right atrial pressure and volume load weight gain are the patients with CS dilatation the reason.