CAJ | 학술논문

目的应用超声心动图监测肺动脉血栓内膜剥脱术(PEA)后血流动力学及右心功能改变情况,评价PEA中远期疗效.方法慢性血栓栓塞性肺动脉高压(CTEPH)患者32例,分别于PEA术前及术后3、12及24个月行经胸超声心动图检查.参数包括肺动脉收缩压(SPAP)、右室舒张末期面积(EDA)、收缩末期面积(ESA)、三尖瓣环收缩期位移(TAPSE)、组织多普勒右室心肌做功指数(MPI)及三尖瓣反流程度(GT1).所有患者于PEA术前及术后3个月行右心导管检查测量肺血管阻力(PVR)及右心输出量(RCO).结果 PEA术后3个月SPAP明显下降,EDA、ESA及MPI减小,TAPSE升高,GT1减低(均P＜0.01).PEA术后12及24个月随访显示患者右心功能进一步改善,其中有2例患者SPAP持续在50 mmHg(1 mmHg=0.133 kPa)以上.MPI与PVR之间呈正相关(r=0.87,P＜0.001),MPI与RCO之间呈负相关(r=-0.77,P＜0.001).结论超声心动图能够评价CTEPH患者PEA术治疗后右心功能及肺动脉压力改善情况.
목적 응용초성심동도감측폐동맥혈전내막박탈술(PEA)후혈류동역학급우심공능개변정황,평개PEA중원기료효.방법 만성혈전전새성폐동맥고압(CTEPH)환자32례,분별우PEA술전급술후3、12급24개월행경흉초성심동도검사.삼수포괄폐동맥수축압(SPAP)、우실서장말기면적(EDA)、수축말기면적(ESA)、삼첨판배수축기위이(TAPSE)、조직다보륵우실심기주공지수(MPI)급삼첨판반류정도(GT1).소유환자우PEA술전급술후3개월행우심도관검사측량폐혈관조력(PVR)급우심수출량(RCO).결과 PEA술후3개월SPAP명현하강,EDA、ESA급MPI감소,TAPSE승고,GT1감저(균P＜0.01).PEA술후12급24개월수방현시환자우심공능진일보개선,기중유2례환자SPAP지속재50 mmHg(1 mmHg=0.133 kPa)이상.MPI여PVR지간정정상관(r=0.87,P＜0.001),MPI여RCO지간정부상관(r=-0.77,P＜0.001).결론 초성심동도능구평개CTEPH환자PEA술치료후우심공능급폐동맥압력개선정황.
Objective To assess the ability of echocardiography to monitor the time course of right ventricular (RV) hemodynamic and functional improvement after pulmonary thromboendarterectomy (PEA).Methods Thirty-two consecutive adult patients who underwent PEA for chronic thromboembolic pulmonary hypertension (CTEPH) were included in the study.Follow-up echocardiography was performed within 3,12,and 24 months of surgery.Systolic pulmonary artery pressure (SPAP),end-diastolic right ventricular areas (EDA),end-systolic right ventricular areas (ESA),tricuspid annular plane systolic excursion (TAPSE),RV myocardial performance index (MPI) and grade of tricuspid valve regurgitation (GT1) were measured by transthoracic echocardiography.All the patients underwent transthoracic echocardiography and right heart catheterization before surgery,pulmonary vascular resistance(PVR)and right cardiac output(RCO) were measured by catheterization.Results Within 3 months after PEA,SPAP decreased significantly,EDA,ESA and MPI decreased (both P ＜0.01),TAPSE increased and GT1 decreased (both P ＜0.01).At the 12 and 24 month follow-up examinations,RV systolic pressure and function remained improved,respectively.The RV systolic pressure remained above 50 mmHg (1 mmHg =0.133 kPa) in only two cases.Pulmonary vascular resistance positively correlated with MPI (r =0.87,P ＜0.001).MPI also negatively correlated with RCO (r =-0.77,P ＜0.001).Conclusions In patients with CTEPH who undergo PEA,echocardiographic measurements of RV pressure and function show improvement,which is a useful tool for the evaluation of RV function.