2025 年第 4 期 第 20 卷

超声心动图在风湿性二尖瓣疾病手术疗效评估中的应用价值研究［

Application value of echocardiography in the evaluation of surgical efficacy of rheumatic mitral valve disease

作者：李晓明1张文博2杜悦1王坚刚2张纯1

英文作者：Li Xiaoming1 Zhang Wenbo2 Du Yue1 Wang Jiangang2 Zhang Chun1

单位：1首都医科大学附属北京安贞医院介入超声科，北京100029；2首都医科大学附属北京安贞医院瓣膜及房颤外科中心，北京100029

英文单位：1Department of Interventional Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Valve and Atrial Fibrillation Surgery Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：风湿性心脏病；二尖瓣；超声心动图；血流动力学

英文关键词：Rheumaticheartdisease;Mitralvalve;Echocardiography;Hemodynamic

• 摘要：

• 目的 探究超声心动图在评估风湿性二尖瓣疾病术后心脏结构及血流动力学状态改善情况方面的应用价值。方法 回顾性纳入2012年3月至2023年6月确诊为风湿性心脏病二尖瓣狭窄和/或关闭不全并于首都医科大学附属北京安贞医院接受二尖瓣置换术或二尖瓣修复术、术后于本院复查超声心动图的112例患者，对比术前与术后的心脏结构和功能指标，以评估术后临床疗效。结果 112例患者年龄（69±3）岁，其中女90例（80.4%），行二尖瓣置换术75例(67.0%)，二尖瓣修复术37例(33.0%)，同期行三尖瓣修复术93例(83.0%)。中位随访时间32（13,62）个月。术后双房左右径、上下径及左心房前后径均明显小于术前(均P<0.001)。术后室间隔运动幅度明显小于术前，二尖瓣瓣口面积明显大于术前，二尖瓣反流面积明显小于术前［（5±2）mm比（7±2）mm、（2.3±0.4）cm2比（1.3±0.5）cm2、2.7（1.9，3.8）cm2比6.0（2.3，10.0）cm2］（均P<0.05）。术后肺动脉收缩压、三尖瓣反流压差、三尖瓣反流峰值流速及三尖瓣反流面积均明显小于术前（均P<0.001）。结论 二尖瓣置换或修复术可显著改善风湿性二尖瓣疾病患者的心脏结构和血流动力学状态，超声心动图是评估手术效果的重要工具。

• Objective To explore the application value of echocardiography in evaluating the improvement of cardiac structure and hemodynamic status after rheumatic mitral valve disease surgery. Methods From March 2012 to June 2023, a total of 112 patients with rheumatic mitral stenosis and/or mitral regurgitation who underwent mitral valve replacement or mitral valve repair in Beijing Anzhen Hospital, Capital Medical University and underwent echocardiography review after operation were retrospectively enrolled. The cardiac structure and function indexes before and after operation were compared to evaluate the postoperative clinical efficacy. Results The mean age of 112 patients was (69±3)years, 90 patients (80.4%) were female. 75 patients (67.0%) underwent mitral valve replacement, 37 patients (33.0%) underwent mitral valve repair, and 93 patients (83.0%) underwent tricuspid valve repair at the same time. The median follow-up time was 32(13,62)months. The diameters of bilateral atria and left atrial anteroposterior diameter after operation were significantly smaller than those before operation (all P<0.001). The amplitude of ventricular septal motion after surgery was significantly smaller than that before surgery, the area of mitral valve orifice was significantly larger than that before surgery, and the area of mitral regurgitation was significantly smaller than that before surgery ［(5±2)mm vs (7±2)mm, (2.3±0.4)cm2 vs (1.3±0.5)cm2, 2.7（1.9，3.8）cm2 vs 6.0（2.3，10.0）cm2］(all P<0.05). Postoperative pulmonary artery systolic pressure, tricuspid regurgitation pressure gradient, tricuspid regurgitation peak velocity and tricuspid regurgitation area were significantly lower than those before operation (all P<0.001). Conclusions  Mitral valve replacement or repair can significantly improve the cardiac structure and hemodynamic status of patients with rheumatic mitral valve disease. Echocardiography is an important tool to evaluate the effect of surgery.