继发孔型房间隔缺损介入治疗的远期随访研究

目的通过对继发孔型房间隔缺损（ASD）介入治疗的远期随访研究，评价其有效性和安全性。方法选择ASD介入治疗的患者61例（男25例，女36例），于手术前、手术后3d、3个月、6个月、1、2、5年分别进行随访，包括询问症状、检查心电图了解有无心律失常；并行超声心动图检查，观察封堵器状态、残余分流情况、心脏结构、心功能、有无封堵伞移位等。结果术后随访，右心房上下径、左右径，右心室舒张末期左右径、右心室舒张末期容积在术后3d就明显缩小，术后3个月进一步缩小（P〈0．05）。右心室舒张末期长径在术后3个月才明显缩小（P〈0．05）。术后3个月，右心室舒张末期容积、右心室收缩末期容积、右心室射血分数较术前进一步改善，差异具有统计学意义（P〈0．01）。术后6个月右心房、右心室大小基本恢复正常。术后3d，左室舒张末前后径、左室舒张末期容积均逐渐增大（与术前比较，尸〈0．05）；左室收缩末期容积、左室每搏量及左室射血分数均逐渐增大（P〈0．05）。3个月后左心功能进一步改善，至12个月时，左心房、左心室大小及左心室功能恢复正常（P〈0．01）。，随访期间，15例出现心悸症状，半年内自愈，无其他并发症。结论ASD介入治疗在消除异常分流的同时，有效改善心脏结构和功能，长期疗效安全有效：

Long - term follow up of secundum atrial septal defect with interventional therapy

Objective To investigate the long- term follow up of secundum atrial septal defect （ASD） with interventional therapy, and to observe the effects and safety. Methods Sixty - one paitents with secundum ASD（25 male, 36 female） underwent transcatheter closure in our hospital. Follow up were made before operation, immediately, 3 days, 3 months, 6 months, 1 year, 2 years, 5 years after operation. The follow up include symptom, electrocardiogram and echocardiography. Results 3 clays and 3 months after transcatheter closure, right atrium diameter, right ventricular end - diastolic left - right diameter and right ventricular end -diastolic volume （RVEDV） decreased significantly （P 〈 0.05）. Right ventricular end - diastolic anteroposterior diameter, RVEDV, right ventricular end - systolic volume and right ventricular ejection fraction decreased significantly at 3 months （P 〈 0.01 ）. At 3 - 6 months, the right cardiac size is stable on normal level roughly. 3 days after transcatheter closure, left ventricular end - diastolic dimension, left ventricular end - diastolic volume, left ventricular end - systolic volume, left ventrieular - stroke volume and left ventricular ejection fraction increased significantly （P 〈 0.05）. At one year, the left cardiac size is stable on normal level roughly（ P 〈 0.01 ）. In follow -up period, 15 patients had palpitation, self- healing within six months, all patients without any other complications. Conclusions Transcatheter closure of secundum atrial septal defect not only can eliminate the abnormal shunt, but also can improve cardiac dimensions and function. Transcatheter closure of secundum atrial septal defect is effective and safe.