| Chronic rheumatic heart disease is one kind of whole heart disease, which involves pathological changes of heart valves, myocardium, and etc. Heart function is decreased in nearly every patient. Artificial valve replacement operation is considered to be an effective therapy. Heart function before and after the procedure is very important because it is related to operation security, evaluation of prognosis and medical therapy . Both left and right heart should be considered in evaluating heart function, but the right heart function is always ignored. The cineangiography and radionuclide ventriculography are the most objective and exact methods in heart function assessment, but they are complex and invasive, their results are affected by factors such as preload ,afterload, myocardial contractility etc, so their applications are limited. The characteristic of myocardial movement need to be evaluated directly.Objective: To evaluate the heart function in patients with rheumatic heart disease before and after valves replacement operation by quantitative tissue velocity imaging.(QTVI) Methods: Twenty-five patients with rheumatic heart disease compared with 20 healthy individuals. The movement of the hearts was observed by QTVI, parameters were measured as follows: the left atria diameter, right atria diameter, left ventricular end diastolic diameter, right ventricular end diastolic diameter, LVEF, RVEF, FS, E velocity of mitral flow, E velocity of tricuspid flow, and Em, Am, SD of the middle part of the septum, annular part of the septum, middle part of left ventricular outside wall, annular part of left ventricular outside wall, middle part of right ventricular outside wall, annular part of right ventricular outside wall, and SD of mitral annuli, tricuspid annuli. The patients were observed and measured at preoperative period, postoperative 1st month and 3rd month respectively. The data were analysed.Results: 1. Observation: â‘ In control group the hearts moved orderly, and the atriums and the ventricles moved harmoniously. The velocity of contraction changes gradient from the apex to the bottom, and the bottom is the fastest. â‘¡ In patients before operation, the movements of heart are turbulence. The movements were not correspond completely between atriums and the ventricles. The gradient changes of contracting velocity in ventricle wall and the septum are broken. â‘¢ There were not significant differences at postoperative 1st month comparing to pre-operation. â‘£ The order of the myocardial movements resumed partly at postoperative 3rd month. 2.Measurement: â‘ Both the atriums and ventricles in patients were larger than ones in control group (P<0.01). LVEF, RVEF, FS were lower than control group (P<0.01). And LVEF continued to reduce 1 month after operation (P<0.05). Left ventricles and left atriums became smaller 3 month after operation (P<0.05). â‘¡The SD of mitral and tricuspid annuli were more lower than control group (P<0.01), and E velocity of mitral flow is higher (P<0.01) . The SD of tricuspid annular continued to reduce and E velocity of mitral flow decreased 1 month after operation (P<0.01). The SD of tricuspid annuli began to increase 3 month after operation (P<0.05). The most parameters relative to septum, outside wall of left and right ventricles in patients are lower than ones in control group (P<0.01).And they decreased after operation 3 months later (P<0.05) ,the parameters relative to diastole in septum and to systole in left ventrcle continued to decrease but parameters in right ventricle began to increase (P<0.05). â‘¢ In patients with chronic atrial fibrillation, the atriums are larger than the other (P<0.05),and SD of tricuspid annular is lower (P<0.01), and E velocity of tricuspid flow is higher (P<0.05), parameters relative to systole in right ventricle are lower (P<0.05). â‘£ SD of mitral and tricuspid annuli, middle part and bottom of septum are larger in group wich patient feel better 3 months after operation (P<0.05).Conclusion:1. DTI/QTVI is fit for observing and measurin... |
