Objective:To investigate the dynamic change of left ventricular systolic synchrony in patients with atrial septal defect (ASD) before and after interventional occlusion using real-time three-dimensional echocardiography (RT-3DE).Methods:A total of 52 patients undergoing interventional occlusion in Zhongshan Hospital from September 2015 to January 2016 were enrolled in this study.All subjects were assigned to take RT-3DE one day before,one day and one month after the interventional occlusion.TomTec 4D LV-Analysis CRT 1.0 software was used to analyze volume-time curves (VTC) of the 16 segments of the left ventricle.Parameters including time to minimal segmental volume (Tmsv),time to minimal segmental volume-standard deviation (Tmsv16-SD),and time to minimal segmental volume-difference (Tmsv16-Dif) were analysed.These three parameters were standardized by dividing cardiac cycle to generate other three parameters:Tmsv％,Tmsv16 SD％,and Tmsv16-Dif％.Results:VTC before the interventional occlusion suggested dyssynchronation of the left ventricular systole;VTC of one day after the interventional occlusion suggested synchronization of the left ventricle.So did the results of one month after the interventional occlusion.Accordingly,parameters including Tmsv,Tmsv％,Tmsv16 SD,Tmsv16-SD％,Tmsv16-Dif,and Tmsv16-Dif％ were significantly improved one day after occlusion as compared with one day before occlusion.These parameters were not significantly changed one month after occlusion as compared with one day after occlusion.In terms of the contraction amplitude,only a few segments showed a significant improvement one day after the interventional occlusion,most segments did not improve until one month later.Conclusions:Interventional occlusion significantly improved left ventricular systolic synchronization in patients with ASD one day after occlusion.Additionally,the contraction amplitude was significantly improved one month after the interventional occlusion.%目的:应用实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)技术评价房间隔缺损(atrial septal defect,ASD)患者介入封堵术前后左心室收缩同步性的变化.方法:选择2015年9月至2016年1月在复旦大学附属中山医院进行介入封堵术的ASD患者52例,于术前1 d、术后1d和术后1个月分别对患者进行RT-3DE检查.应用TomTec 4D LV-Analysis CRT 1.0软件,绘制左心室各节段的容积-时间曲线(volume-time curve,VTC),并计算16节段达到最小容积的时间(time to minimal segmental volume,Tmsv)及其标准差(time to minimal 16-segmental volume-standard deviation,Tmsv1 6-SD)、最大差值(time to minimal 16-segmental volume-difference,Tmsv16-Dif).将上述数据与受检者心动周期时间相除之后标化,得到Tmsv％、Tmsv16-SD％、Tmsv16-Dif％.定量分析左心室各节段术前及术后收缩幅度的变化情况.结果:VTC显示:术前1d,ASD患者左心室16节段收缩同步性较差;术后1d,左心室16节段收缩同步性得到改善;术后1个月与术后1d改变相似.ASD患者术后1 dTmsv及Tmsv％、Tmsv16 SD及Tmsv1 6-SD％、Tmsv16-Dif及Tmsv16-Dif％均较术前1d改善(P＜0.05);术后1个月与术后1d差异无统计学意义.术后1d,仅少数左心室节段出现收缩幅度的明显改变;术后1个月大部分节段的收缩幅度明显改善(P＜0.05).结论:ASD患者术前左心室各节段收缩同步性及收缩幅度均较差;术后1d左心室各节段收缩同步性即得到改善,但收缩幅度改善不明显;术后1个月,左心室各节段收缩同步性改善不明显,但收缩幅度改善明显.
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