CAJ | 학술논문

目的探讨特发性二尖瓣瓣下左心室室壁瘤(idopathic submitral left ventricular aneurysm,ISLVA)患者的临床特征,并对其左室整体收缩功能、节段收缩功能及左室舒张功能进行超声心动图评价.方法对8例ISLVA患者的临床特征进行回顾性分析,并对其及20例对照者行常规超声心动图及实时三维超声心动图检查.结果 8例ISLVA患者中2例因出现室性心律失常、6例因出现心力衰竭而被诊断,冠状动脉造影无异常,心尖区可闻及收缩期杂音(6例).4例行二尖瓣手术,1例行室壁瘤切除和射频消融术,1例安装埋藏式心脏复律除颤器,1例仅行药物治疗,死亡1例.ISLVA组的左房、左室舒张末期及左室收缩末期内径均大于对照组(P＜0.05),左室后壁厚度较对照组小(P＜0.05),左室射血分数低于对照组(P＜0.05);ISLVA组的左室16节段(6个基底段、6个中间段和4个心尖段),左室12节段(6个基底段和6个中间段)和左室6个基底段的达最小收缩容积时间(Tmsv)的标准差(Tms、v16-SD、Tmsv 12-SD、Tmsv 6-SD)及最大时间差(Tmsv 16-Dif、Tmsv 12-Dif、Tmsv 6-Dif),及其心率校正值均高于对照组(P均＜0.05).所有ISLVA患者均有不同程度的二尖瓣反流和左室舒张功能减退,5例伴有左房压增高.结论 ISLVA患者的临床特征无特异性,超声心动图能全面评价其结构和功能异常.
목적 탐토특발성이첨판판하좌심실실벽류(idopathic submitral left ventricular aneurysm,ISLVA)환자적림상특정,병대기좌실정체수축공능、절단수축공능급좌실서장공능진행초성심동도평개.방법 대8례ISLVA환자적림상특정진행회고성분석,병대기급20례대조자행상규초성심동도급실시삼유초성심동도검사.결과 8례ISLVA환자중2례인출현실성심률실상、6례인출현심력쇠갈이피진단,관상동맥조영무이상,심첨구가문급수축기잡음(6례).4례행이첨판수술,1례행실벽류절제화사빈소융술,1례안장매장식심장복률제전기,1례부행약물치료,사망1례.ISLVA조적좌방、좌실서장말기급좌실수축말기내경균대우대조조(P＜0.05),좌실후벽후도교대조조소(P＜0.05),좌실사혈분수저우대조조(P＜0.05);ISLVA조적좌실16절단(6개기저단、6개중간단화4개심첨단),좌실12절단(6개기저단화6개중간단)화좌실6개기저단적체최소수축용적시간(Tmsv)적표준차(Tms、v16-SD、Tmsv 12-SD、Tmsv 6-SD)급최대시간차(Tmsv 16-Dif、Tmsv 12-Dif、Tmsv 6-Dif),급기심솔교정치균고우대조조(P균＜0.05).소유ISLVA환자균유불동정도적이첨판반류화좌실서장공능감퇴,5례반유좌방압증고.결론 ISLVA환자적림상특정무특이성,초성심동도능전면평개기결구화공능이상.
Objective To study cinical features of patients with idopathic submitral left ventricular aneurysm(ISLVA) and evaluate their global and segmental systolic function as well as diastolic function through echocardiography.Methods Clinical features of eight patients with ISLVA were analysed retrospectively.Standard 2-dimentional and real-time 3-dimentional echocardiography were performed in all the eight cases and other twenty subjects with normal left ventricular(LV) function (defined as control group).Results Two patients were diagnosed as ISLVA due to ventricular arrythmia and the other six case sowing to congestive heart failure.Coronary angiography was normal in all patients.Apical systolic murmur was audible in 6 cases.Four patients received mitral valve surgical repair,one underwent aneurysm resection and radiofrequency ablation,implantable cardioverter defibrillator was implanted in one case,one was only treated by medication.One case died.Patients with ISLVA demonstrated significanly larger left atrium(LA) and LV diameter (both end-diastolic and end systolic),thinner LV posterior wall,and lower LV ejection fraction (LVEF) than controls (P ＜0.05).Indexes of the LV 17 segments time-volume curves including the time to minimal systolic volume(Tmsv) 16-SD,Tmsv 12 SD,Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD％,Tmsv 12-SD％,Tmsv 6-SD％,Tmsv 16-Dif％,Tmsv 12-Dif％,Tmsv 6-Dif％ were significantly higher in patients with ISLVA than those in controls(all P ＜0.05).All patients with ISLVA showed mitral regurgitation and decreased LV diastolic function in varying degrees,five patients accompanied by elevated LA pressure.Conclusions Clinical features of patients with ISLVA are nonspecific.Echocardiography can evaluate systematically their functional and structural abnormalities.