不同年龄段房间隔缺损封堵对心脏重构及心功能的影响

目的:观察各年龄段继发孔型房间隔缺损经导管介入封堵治疗后对心脏几何形态学及右心功能变化的影响.方法:回顾性分析,998-06/2008-10贵州省人民医院心内科收治的房间隔缺损患者109例,男53例,女56例,年龄3.5-70岁.按年龄段分为儿童组(年龄≤7岁,n=31),青少年组(年龄8-18岁,n=42)和成人组(年龄＞18岁,n=36).应用经胸超声心动图分别测量各年龄段房间隔缺损患者经导管房间隔缺损封堵治疗前和治疗后6个月收缩末期左房横径、右房横径、右房横径左房横径、右心室舒张末期内径、左心室舒张末期内径、右心室舒张末期内径左心室舒张末期内径、肺动脉内径及左右心室射血分数的变化.结果:与术前相比,各组房间隔缺损封堵后6个月,右房、右室内径、肺动脉内径缩小,右房横径/左房横径和右心室舒张末期内径/左心室舒张末期内径明显下降,左房、左室内径增大,左、右室射血分数明显改善(P< 0.05-0.01);但儿童组心脏重构逆转及心功能改善程度明显大于青少年组及成人组(P<0.05),青少年组和成人组相比,差异无显著性意义(P＞0.05).结论:继发孔型房间隔缺损介入治疗对不同年龄患者均能有效逆转心脏重构、改善心功能,但儿童阶段效果更好.

Influence of transcatheter closure for atrial septal defects on heart remodeling and ventricular function in patients at different ages

OBJECTIVE: To investigate the geometric changes and ventricular function of heart after percutaneous closure of atrial septal defect according to patient age at the time of the procedure. METHODS: A total of 109 patients with atrial septal defect admitted to Department of Cardiology, Guizhou Provincial People's Hospital between June 1998 and October 2008 were retrospectively analyzed, including 53 males and 56 females aged 3.5-70 years. According to their age, the patients were divided into child group (aged=7 years, n=31), adolescent group (n=42, aged 8 18years) and adult group (n=36, aged > 18 years). Cardiac remodeling was assessed by transthoracic echocardiography before ASD closure and 6 months after atrial septal defect closure, including lateral diameter of left and right atrium (LALD, RALD), ratio of LALD/RALD, diastolic diameter of left and right ventricle (LVDD, RVDD), RVDD/LVDD ratio, and pulmonary diameter (PD), ejection fraction (EF) of LV and RV. RESULTS: 109 patients were all included in final analysis. Compared with preoperative results, the right atrium, RALD, RVDD,RALD/LALD, RVDD/LVDD ratio and PD were significantly decreased, while the left atrium and LALD significantly increased,and EF of left and right atrium was remarkably improved 6 months following atrial septal defect closure (P< 0.05-0.01).Moreover, the heart remodeling and heart function amelioration after atrial septal defect closure of child group were better than adolescent and adult groups (P < 0.05), but there were no significant differences between adolescent and adult groups (P>0.05).CONCLUSION: Transcatheter closure of atrial septal defect is safe and effective for all patients of different ages; in particular,results at children stage are better than adolescent and adult stages.