| PartⅠ:The changes of left ventricular function after surgical treatment of left ventricular aneurysmBackground and objective:Because left ventricular geometry changes significantly in patients with left ventricular aneurysm (LVA), the accuracy of two dimensional echocardiography and left ventricular angiography is limited in measuring left ventricle volume and other parameters by geometric assumptions. Real-time three-dimensional echocardiography (RT-3DE) is widely used in clinical practice nowadays due to the ability to describe the real geometry by three-dimensional reconstruction of left ventricle, and the advantages of low cost and mobility. In this prospective study, we evaluated left ventricular systolic and diastolic functions, and assessed the changes of left ventricular segment ejection fraction for the first time before and after surgical treatment of LVA by RT-3DE and tissue Doppler imaging (TDI) respectively.Methods:From February 2009 to February 2010,18 coronary artery disease patients combined with post-myocardial infarction and LVA were included in this study. Forteen patients were followed up for a mean period of 4 months. Left ventricular function was evaluated by by two-dimensional echocardiography, RT-3DE and TDI preoperatively and during follow-up. At the same time,12 healthy persons were included as controls. Statistical analyses of various left ventricular function parameters were carried out among preoperative group, postoperative follow-up group and normal control group.Results:All patients underwent LVA repair and coronary artery bypass grafting. At postoperative follow-up, RT-3DE showed that left ventricular end-systolic volume index (LVESVI) decreased from 57.08±21.26ml/m2 to 34.34±9.90ml/m2 (P=0.001), ejection fraction (EF) increased from 0.3499±0.063 to 0.4471±0.0817 (P=0.002). There were significant differences in LVESVI and EF among preoperative group, postoperative follow-up group and normal control group. Preoperative regional EF progressively increased from apex to base. Except inferior basal segment, lateral-inferior basal segment and lateral-anterior basal segment, regional EF in the remaining 14 segments were significantly lower than that of control group. At postoperative follow-up, the same to control group, regional EF progressively increased from base to apex, and there was no significant difference between lateral segment regional EF and that of control group. In the assessment of diastolic function, compared to baseline, transmitral Doppler flow echocardiograph showed that the early/late-diastolic filling velocities (E/A) significantly increased in the postoperative early and mid-term follow-up period (P=0.014). TDI also demonstrated that the mean of the early-diastolic lateral and septal mitral annular velocities (Earn) and the early-diastolic lateral mitral annular velocities (Eal) significantly increased postoperatively (P=0.022; P=0.007). Furthermore, there was no significant difference in E/A, Eal, E/Eal between postoperative follow-up group and control group.Conclusion:RT-3DE is an effective method to assess left ventricular systolic function in patients with LVA. After LVA repair and coronary artery bypass grafting, left ventricular global systolic function improved, regional systolic function restored to the normal direction of progressive increase, but left ventricular global and most regional systolic function did not return to the normal state. Left diastolic function returned to normal. We speculate that the key to surgical treatment of LVA is exclusion of scar tissue, restoration of left ventricular regional geometry and reduction in border zone stress, and furter to reduce left ventricular cavity pressure by decreasing left ventricular volume, which can help left ventricular function recover. PartⅡ:The clinical study of the changes of left ventricular geometry after surgery in left ventricular aneurysm by RT-3DEBackground and objective:Compared with two-dimensional echocardiography and left ventricular angiography, real-time three-dimensional echocardiography (RT-3DE) has unique advantages in evaluating left ventricular geometry by the real three-dimensional reconstruction. Left ventricular aneurysm (LVA) shows various degrees of left ventricular global and local geometry abnormality, and to restore normal left ventricular geometry is an important part of surgical treatment. In this prospective study, we evaluated left ventricular geometry before and after surgical treatment of LVA by RT-3DE for the first time. In addition, we designed two novel geometric parameters, including ellipsoid index (EI) and apical index (AI), to quantitative left ventricular global and local geometry abnormality respectively, besides sphericity index (SI) and conic index (CI).Methods:From February 2009 to February 2010,18 coronary artery disease patients combined with post-myocardial infarction and LVA were included in this study. Preoperative and postoperative left ventricular shape was evaluated by RT-3DE and SI, CI, EI and AI were measured. Forteen patients were followed up for a mean period of 4 months. At the same time,12 healthy persons were included as controls. Statistical analyses of various left ventricular geometric parameters were carried out among preoperative group, postoperative follow-up group and normal control group.Results:Compared with normal control group, the diameters of left ventricular long axis and short axis, end-systolic SI, CI and El increased significantly in preoperative patients. At 4th month after operation, the diameters of left ventricular long axis and short axis decreased, but only significant in the former; in addition, SI increased, CI, El and end-systolic AI decreased, however, there was no significant difference in any of these parameters between preoperative group and postoperative follow-up group. And there was no significant difference in end-systolic AI between postoperative follow-up group and control group. Conclusion:RT-3DE can assess left ventricular geometry in patients with LVA accurately. The left ventricular shape changed significantly in LVA patients preoperatively. Left ventricular geometric parameters measured at end-systolic phase were more accurate than those in end-diastolic stage to assess the changes of left ventricular shape preoperatively. During follow-up, echocardiography demonstrated that the length of left ventricular long axis decreased significantly, but the length of short axis did not changed significantly. Left ventricular global shape did not improve significantly, and apical shape was close to normal postoperatively. According to our study, we think that El and AI are valid geometric parameters to assess the global left ventricular geometry and the left ventricular apical geometry respectively. |
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