| ObjectivePulmonary venous patterns and hemodynamics in normal patients and patients with atrial fibrillation are of respective features and changes.Most idiopathetic tachycardia of left ventricle of the heart originates from middle and posterior septums of left and posterior branchings without organic cardiopathy,but its chronic and constant attacks tend to cause tachycardiac cardiomyopathy.Now the radio frequency catheter ablation has become a major non-medication therapeatical method.The page is to make a comparative study between pulmonary venous internal diameter and hemodynamic parameters.Evaluated by transthoracic echocardiography(TTE)and those by transesophageal echocardiography(TEE).Real-Time Three-Dimensional Echocardiography(RT-3DE)and its quantitative analysis software were adopted synchronally to analyse mechanical activities in 17 segments of the left ventricle of the heart and evaluate ventricular wall kinetic changes when ventricular arrhythmias were treated by the radio frequency catheter ablation.Methods1.Normal control group(group A):All together 50 patients between 18 and 68 years old,with the average age of 43 years old,including 35 men and 15 women, underwent TTE and TEE studies.30 of them underwent RT-3DE studies.No abnormality was observed in cardiac structure.2.Paroxysmal atrial fibrillation group(group B):Totally there were 90 patients between 21 and 68 years old,average age of 44 years old,including 34 men and 16 women.3.Persistent atrial fibrillation(group C):total 50 patients between 42 and 86 years old,with the average age of 64 years old,including 38 men and 12 women.Both group B and group C underwent TTE and TEE studies before the radio frequency catheter ablation;all of them were reexamined by TTE,and 50 of them were reexamined by TEE.4.Group with sinus rhythm converted after the radio frequency catheter ablation (group D):25 patients underwent TEE studies 3 months after the operation.All of them converted into sinus rhythm.5.Group with atrial fibrillation after the radio frequency catheter ablation(group E): 15 patients with atrial fibrillation who were not cured were to undergo the radio frequency catheter ablation for the second time.6.Group of RT-3DE radio frequency catheter ablation(group F):15 patients.Instrument:Philips IE 33 and GE Logic 500 of Color Doppler ultrasonic diagnostic apparatus made in the USA were used.The pulmonary venous lines,the entrance to the left atrium,and internal diameter at the entrance of the pulmonary veins were observed in apical four-chamber and five-chamber view of TTE.The pulmonary venous flow and its frequency spectrum patterns were observed and measured by CDFI and PW.An ideal frequency spectrum of pulmonary venous flow could be obtained if the sample volume was placed at 0.5-1.0 cm away from the entrance of left or right upper pulmonary vein. Scanning within -15°～180°were available by TEE.The frequency spectrum of pulmonary venous flow could be recorded when the sample volume of PW was at the entrance of left or right upper pulmonary vein under the guidance of CDFI.The sampling line of PW should be as parallel as possible to the direction of blood flow by adjusting the direction of acoustic beam carefully.The quantitative analysis was made by use of QLab 4.0 analysis software 3DQ advanced of IE33 type.The time-volume curves in 17 segments were shown.Results1.The four pulmonary veins were displayed by TTE and TEE as followsBy TTE displayed were 90%of the left upper pulmonary veins,86%of the right upper pulmonary veins,40%of the left inferior pulmonary veins,and 2%of the right inferior pulmonary veins.And by TEE,were 100%of both the left and right upper pulmonary veins,85%of the right inferior pulmonary veins,and 83%of the left inferior pulmonary veins.No obvious difference was found between the results of the pulmonary venous internal diameter calculated by TTE and TEE.Left and right upper pulmonary venous flow rates were measured.Normal frequency spectrum of pulmonary venous flow includes one negative wave A and three positive waves,S1,S2,and D,and S2/D＞1.However TTE could record only waves S2,wave D,and wave A,while TEE could record all the stages of the frequency spectrum of pulmonary venous flow.2.The influence of PW sampleing depth upon the frequency spectrum of pulmonary venous flowwe at the spots measured the flow rates of the sample volumes 0.5cm,1.0cm. 1.5cm,2.0cm,and 2.5cm away from the entrance of upper pulmonary veins.Especially the left one the frequency spectrum of pulmonary vein was available at the entrance of the pulmonary vein in 50 patientst when the flow rate at diastolic stage was reduced as the sample volume was deepened.The frequency spectrum was available at the spot 2.5 cm away from the entrance of pulmonary vein in 32 patients.The shape,pattern,and quality of frequency spectrum were optimal when the sample volume was 0.5 to 1.5 cm away from the entrance of pulmonary vein.The influence of TEE at different angles: when the angle between acoustic beam and blood flow was less than 20°,the left and right upper pulmonary venous flow was detected,and the internal diameter and frequency spectrum of blood flow could be clearly measured;only the entrance of the left inferior pulmonay vein to the atrium could be displayed by TEE and not an ideal frequency spectrum of blood flow since the left inferior pulmonary vein is on the posterior wall of the atrium.3.There was no obvious difference in pulmonary venous internal diameter between the group with paroxysmal atrial fibrillation and the normal group,however the pulmonary venous internal diameter became greater in the group with persistent atrial fibrillation,especially in the left and right upper pulmonary veins.The difference in pulmonary venous internal diameter was not obvious before and after the radio frequency catheter ablation.At early systolic stage of atrial fibrillation Wave S1 and wave A disappeared,but early systolic reversal flow(ESR)appeared after wave R in electrocardiogram.Velocity of wave S was brought down,that of wave D was quickened,and S/D＜1.The pulmonary venous flow pattern returned to normality in 25 patients with converted sinus rhythm after the radio frequency catheter ablation.Wave S1,wave S2,wave D,and wave A could be detected,but wave ESR disappeared, however,S/D≤1.In 15 patients,still with paroxysmal atrial fibrillation or persistent atrial fibrillation,the pulmonary venous flow pattern was the same as that before therapy.4.No left atrial appendage thrombus(LAATh)could be detected in the group with paroxysmal atrial fibrillation by TTE,but by TEE LAATh was detected in 6 out of 90 patients,accounting for 6.6%.However,LAATh was detected in 4 out of 50 patients by TTE in the group with persistent atrial fibrillation,accounting for 8%;and it was detected by TEE in 20 patients,accounting for 40%.Meanwhile,3 patients were found to have right atrial appendage thrombus(RAATh),accounting for 6%.Two pieces of LAATh were detected in 15%of the patients with LAATh.3%of the patients were detected to have thrombus in both appendages.5.The radio frequency catheter ablation therapy for the left ventricle idiopathetic tachycardia is mainly in the middle and posterior part of interventricular septum.The left ventricle's function was normal in the 17 segment before operation,and the time-volume curve was regular and in order.The interventricular septum and lateral wall were good in synchronicity.There was no significant difference statistically between the interventricular septum and lateral wall reexamined by RT-3DE after one-week's therapy.Conclusion1.2 to 3 pulmonary veins can be displayed by TTE,and good frequency spectrum of blood flow can be detected in the right upper pulmonary vein.The four pulmonary veins can be displayed by TEE,and the display quality of frequency spectrum of both the left and right upper pulmonary veins is optimal.TEE is of better display rate than TTE.Normal pulmonary veins at four stages,wave S1,wave S2,wave D,and wave A can be observed by TEE in patients with sinus rhythm.Only wave S2,wave D,and 75% of wave A can be detected by TTE.Wave S1 and wave A disappear in patients with atrial fibrillation,S/D＜1,and wave ESR appears.The form,pattern,and quality of the frequency spectrum are optimal when a sample volume is placed at 0.5-1.5 cm away from the entrance of pulmonary vein.The blood flow rate of pulmonary vein furter away than 2.5 cm in a diastole reduces with a deepened sample volume.2.Before and after the radio frequency catheter ablation the internal diameter of pulmonary vein is normal in patients with paroxysmal atria fibrillation,but is wider in patients with persistent atrial fibrillation,especially in the left and right upper pulmonary veins,and there is no change after the radio frequency catheter ablation.3.TEE is more sensitive to detect LAATh and RAATh than TTE.The incidence rate of LAATh in patients with persistent atrial fibrillation is as high as 40%,and thrombus may occur at the same time in both appendages.Pulmonary venous stenoses occurring after the radio frequency catheter ablation can be observed by TEE.4.The systolic function of local cardiac muscles in the left ventricle does not change obviously after the radio frequency catheter ablation therapy for idiopathetic ventricular tachycardia of the left ventricle.The kinetic coordination of the ventricular wall in 17 segment is good,and the time-volume curve is regular and in order.The radio frequency catheter ablation is an effective and safe therapeutic method for treating supraventricular and ventricular arrhythmias;RT-3DE is an important method to evaluate exactly and quickly the segmental systolic function of the left ventricle without any injury. |
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