国产封堵器介入治疗房间隔缺损后心功能变化的研究

目的探讨国产封堵器介入治疗房间隔缺损(ASD)后心脏形态和功能的变化规律。方法全组60例,年龄5～35(16.10±10.71)岁,体重17～7(243.91±13.21)kg,经胸超声心动图(TTE)示ASD最大径7～3(618.3±7.2)mm,选用封堵器型号为10～4(026±3)mm。术后3d、3个月、6个月和12个月行TTE追踪测量。采用心尖四腔切面面积-长度法计算左右心室容积及射血分数。结果术后3d,右心房上下径、左右径,右心室舒张末期前后径、左右径均逐渐减小(与术前比较,P<0.05);右室舒张末期容积(RVEDV),右室收缩末期容积(RVESV),及右室射血分数(RVEF)均逐渐减小(与术前比较,P<0.05)。3～6个月随访,右心功能进一步改善。至12个月随访时,右心房、右心室大小及右心功能恢复正常(与术前比较,P<0.01)。术后3d,左室舒张末期前后径(LVEDD),左室舒张末期容积(LVEDV)均逐渐增大(与术前比较,P<0.05);左室收缩末期容积(LVESV),左室每搏量(LVSV)及左室射血分数(LVEF)均逐渐增大(与术前比较,P<0.05)。3～6个月随访,左心功能进一步改善。至12个月随访时,左心房、左心室大小及左心室功能恢复正常(与术前比较,P<0.01)。结论国产封堵器介入封堵ASD,既阻断了异常分流,又改善了左心室及右心系统功能及其几何构型。     

房间隔缺损封堵术后右心形态和功能的变化

目的 :评价继发孔房间隔缺损 (房缺 )封堵术后及随访中右心形态及右心室功能的变化。方法 :全组患者 36例 ,男性 11例 ,女性 2 5例 ,年龄 5～ 5 6 ( 2 7 2± 14 6 )岁。均用Amplatzer封堵器治疗。于封堵术前 1天、术后 2天、术后 3个月分别行超声心动图检查 ,右心室容积采用面积长度法计算。结果 :房缺封堵术后 2天及 3个月随访 ,右心房上下径、左右径 ,舒张末期右心室前后径、左右径均进行性改善 ,与术前比较 ,有显著差异 (P <0 0 5～ 0 0 1)。术后 2天 ,右心室的舒张末期容积 ,每搏输出量、射血分数均较术前明显改善 ,有显著性差异 (P <0 0 5 )。术后 3个月右心室的舒张末期容积、收缩末期容积、每搏输出量、射血分数较术前进一步改善 ,均有显著差异 (P <0 0 1)。结论 :房缺封堵术后及短期随访中 ,右心形态进行性改善 ,主要表现在右心房上下径、左右径及右心室舒张末期前后径、左右径进行性缩小 ;右心室的高动力循环状态术后虽明显减轻 ,但随访中右心功能无明显改变 ,保持了正常的右心功能     

房间隔缺损封堵术后心功能的变化

目的 评价左、右室功能及左房收缩功能在房间隔缺损（ASD）封堵治疗术后及随访中的变化。方法 对成功施行经皮穿刺ASD封堵术的20例患进行研究。所有患于封堵治疗术前、术后及术后3个月行超声心动图检查,左、右室容积采用单平面面积-长度法计算,以左室晚期充盈数作为反映左房收缩功能的指标。结果 ASD填充堵治疗术后,左室舒张末期前后径及及左室舒张末期容积增大,而左室收缩末期容积则未见明显改变,左室每搏量、左室射血分数及短轴缩短率增大。左客观存在偏心率及长径/短径比值均较术前缩小,左室前负荷、收缩功能及几何构型在随访中持续改善。ASD封 堵治疗术后右室舒张末期前后径、右室舒张末期容积、右室收缩末期容积、右室每搏量及右室射血分数（RVEF）均减小;随访中上述指标除RVEF外均进一步减小,而RVEF未见显改变,置入封堵器后及随访左室晚期充盈分数,差异无显性。结论 ASD封堵治疗既减轻了右室的容量铅荷,也改善了左室的收缩功能及几何构型,在短期随访中,左室功能及几何构型持续改善,右室功能维持于正常水平,置入封堵器对左房收缩功能未产生显影响。     

国产封堵器治疗房间隔缺损的应用

目的:评价应用国产封堵器治疗继发孔型房间隔缺损（ASD）的初步疗效。方法:31例ASD患者,ASD直径为1034（19±8）mm。所有患者在X线及经胸超声心动图（TTE）监视下经导管置入国产房间隔封堵器。治疗术后及术后3个月随访超声心动图、胸片、心电图,观察对血流动力学及心功能的影响。结果:全组手术成功率为100%,术后即刻及随访未见残余分流。与术前比较,三尖瓣口、肺动脉瓣口血流峰值明显降低,二尖瓣口血流峰值增加（P<0.05）,术后及随访期右心房、右心室内径缩小,右室射血分数早期下降,后期无明显变化。左室功能无明显变化,无出现新的心律失常和脑栓塞等并发症。结论:国产房间隔封堵器可有效治疗ASD,操作方便,手术成功率高,疗效可靠。有效改善右心高容量负荷状态。     

超声心动图评价成人房间隔缺损封堵术后心脏结构和功能的变化

目的探讨超声心动图评价成人房间隔缺损(atrial septal defects,ASD)介入封堵术后心脏形态和功能变化。方法经超声心动图和心电图检查确诊为ASD并成功施行ASD封堵术的患者74例,年龄(35.63±12.74)岁,ASD直径为(16.29±5.11)mm。于封堵器堵闭术后24h、1个月、3个月、6个月和12个月进行经胸超声心动图追踪测量主动脉内径、左心室舒张末内径、左心室收缩末内径和右心室前后径,肺动脉内径和肺动脉瓣血流速度,右心房和右心室的上下径、主动脉瓣口血流速度、二尖瓣口血流速度、三尖瓣口血流速度和左心室射血分数,同时测量封堵器的直径和长度,并进行统计学分析。结果术后24h与术前相比,右心房内径、右心室内径、肺动脉内径、三尖瓣口血流速度和肺动脉瓣口血流速度均显著减少(P0.01);左心房内径、左心室内径、主动脉内径、二尖瓣口血流速度和主动脉瓣口血流速度均显著增加(P0.05);左心室射血分数无明显变化。房室大小和血流速度在术后24h内变化明显,在术后1个月后的随访中逐渐趋于稳定。结论封堵器介入封堵ASD,既纠正了解剖畸形,又改善了左心和右心系统的几何结构。     

二维超声心动图及组织多普勒检测房间隔缺损封堵术前后右心负荷的变化

目的 :探讨房间隔缺损 （ASD）封堵术对右心负荷改善的作用以及超声心动图检测价值。方法 :应用超声心动图对 46例经心导管 ASD封堵术患者的术前及术后右心负荷变化情况进行检测。二维超声心动图测量右心房及右心室大小 ,组织多普勒测量右室基底部和中部收缩期运动速度 （S’ ）、舒张早期运动速度 （E’ ）及舒张晚期运动速度（A’ ）。结果 :本组患者超声测量 ASD直径为 8～ 3 6（2 4± 7） mm,置入 Amplatzer封堵器大小为 12～ 40 （2 8± 7） mm。右房横径和长径、右室前后径、横径和长径以及右室横截面积术后 48h和 3月比术前明显减小 （均 P<0 .0 1）。右室侧壁基底部及右室侧壁中部组织运动速度术后 48h和 3月比术前明显降低 （均 P<0 .0 1）。结论 :ASD封堵术后右心负荷明显减轻 ,二维超声心动图及组织多普勒可用于右心负荷改善的检测     

经导管封堵房问隔缺损对心脏结构及血中利钠肽水平的影响

目的：观察用国产Amplatzer封堵器治疗继发孔型房间隔缺损（ASD）前后心脏结构及血浆心钠肽（ANP）、脑钠肽（BNP）的变化．探讨经导管ASD封堵术的影响。方法：应用超声心动图测量36例ASD患者封堵治疗前、治疗后1d、1月、3月、6月心脏结构参数,并分别测定相应时段血浆心钠肽、脑钠肽的浓度,另选取年龄及性别与之相匹配的健康人36例作为对照组。结果：同术前相比,术后1d、1月、3月、6月,右房、右室内径明显缩小（P〈0．05）,而左室舒张末期内径在术后1月、3月明显增大（P〈0．05）。左室收缩末期内径、左房内径及左室射血分数在术前及术后没有明显变化。ASD组ANP、BNP水平在封堵前较对照组明显升高,在封堵1d后开始显著逐渐下降,到6月后基本恢复至正常水平（P均〈0．05）。结论：经导管ASD封堵术减轻了右心的容量负荷．使右房、右室内径明显缩小,也可在短期内改善左室的几何构型,血浆ANP、BNP水平可以作为评价经导管ASD封堵术对心脏容量负荷影响的一项有效指标。     

超声心动图评价房间隔缺损封堵术心脏血流动力学及其负荷的变化

目的应用经胸超声心动图（TTE）评价房间隔缺损（ASD）封堵术前、后心脏血流动力学及负荷的变化。方法西京医院ASD封堵术患者30（女23,男7）例,年龄4.563（28±18）岁。于封堵术前、术后3 d、3个月及6个月行TTE检查。测量肺动脉瓣口、三尖瓣口血流速度,左、右心室和心房大小变化。结果ASD封堵术后3 d、3个月、6个月:肺动脉瓣口最大流速、平均流速、速度时间积分以及三尖瓣口E峰和A峰值血流速度较术前显著降低（P<0.01）;肺动脉中段内径、右心房和右心室各径较术前显著减小（P<0.01）;左心房、左心室各径较术前增大（P<0.05,P<0.01）。术后各个时间点比较各指标也有不同程度改善。结论ASD封堵治疗后患者血流动力学异常和心腔前负荷变化得以纠正。TTE在ASD封堵术后的疗效观察中具有重要的作用。     

超声心动图引导下经胸微创房间隔缺损封堵术34例临床观察

目的 探讨彩色超声心动图（TTE）在经胸微创房间隔缺损（ASD）封堵术中的应用价值.方法 对34例ASD患者行经胸微创封堵术,并于术前采用TTE测量各切面ASD长度及周缘情况,术中采用TTE监测封堵过程,术后采用TTE观察心房水平有无残余分流、封堵伞有无脱落及右心系统回缩情况.结果 TTE测量ASD长度为（14.54±7.05）mm,所选封堵器型号大于TTE测量值4～6 mm;33例经胸微创ASD封堵术成功,1例因ASD长度大、一侧无残端组织而无法牢固放置封堵器改开胸手术缝补;术后随访1周、1个月均无残余分流,封堵器封堵牢固、无脱落;右心系统回缩明显.结论 TTE用于经胸微创ASD封堵术能于术前准确测量ASD大小、术中及时监测与引导封堵过程、术后准确观察有无残余分流并评价疗效.     

经胸超声和造影测量法指导国产封堵器介入治疗先心病的价值

目的探讨经胸超声（TTE）和造影测量法指导国产封堵器介入治疗房间隔缺损（ASD）、室间隔缺损（VSD）和动脉导管未闭（PDA）的应用价值。方法术前应用TTE筛选符合封堵适应证的先心病患者50例，其中ASD20例、VSD16例、PDA14例。术中用TTE监测指导释放ASD封堵器；使用造影测量法测量VSD、PDA指导国产封堵器的选择。术后应用TTE定期随访。结果19例ASD、15例VSD、14例PDA封堵成功，总成功率为96．0％（48／50）。封堵失败：1例ASD，缺损最大径36mm；1例VSD，缺损最大径10mmm，为膜周部室缺。结论TTE可用于筛选先心病病例。术中用TTE监测指导释放ASD封堵器，疗效可靠；使用造影测量法测量VSD、PDA指导国产封堵器的选择是手术成功的基本条件之一。     

Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect

Background: Right ventricular (RV) volume overload is a well‐known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long‐term complications. Thus cardiac volumetric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD. Methods: We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transthoracic echocardiographic studies, including three‐dimensional echocardiography and right ventricular myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure. Results: We found that: (1) the right ventricular end‐diastolic volume (RVEDV) and right ventricular end‐systolic volume (RVESV) (respectively 106.54±25.97 vs 69.78±10.46 mL, P < 0.05; 59.73±17.59 vs 33.84±7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ventricular ejection fraction (RVEF) (44.82%±4.51% vs 54.11%±5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61±16.49] ms vs (64.09±11.82) ms, P < 0.05; [28.04±9.57] ms vs [20.45±6.53] ms, P < 0.05) were prolonged and ejection time ([250.02±24.21] ms vs [272.73±20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41±0.07 vs 0.31±0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly. Conclusions: Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

介入封堵术在老年继发孔型房间隔缺损患者中的临床应用

目的观察老年继发孔型房间隔缺损(ASD)患者进行介入封堵术的中、远期疗效和安全性。方法老年继发孔型ASD患者206例,缺损8～38(26.5±8.1)mm。封堵术前、术后行右心导管检测肺动脉压、右心室压,随访6个月,评价心功能(NYHA)改善情况。结果成功封堵203例,成功率98.5%。封堵器直径12～42(31.5±7.3)mm。与封堵术前比较,患者封堵术后肺动脉收缩压、右心室平均压明显下降(P<0.05,P<0.01);3～6个月随访时,患者右心室容积缩小、LVEF升高、心功能改善明显。术后心包积液1例(0.5%);即刻残余分流10例(4.9%);术后出现心律失常30例(14.8%)、出现急性心功能不全16例(7.9%)。6个月随访,患者均未发现有残余分流、脱落、栓塞。结论老年继发孔型ASD患者行介入封堵治疗中、远期相对安全、有效。     

超声心动图评价室间隔缺损封堵术后左心功能及形态的变化

目的 探讨超声心动图对室间隔缺损封堵术后左心功能及形态变化的评价作用.方法 60例接受Amplatzer封堵器封堵治疗的室间隔缺损患者,于术前1天、术后3天、3月及6月行经胸超声心动图检查,测量左心室舒张期末内径、左心室舒张期末容积、左心室收缩期末容积、左心房收缩期末内径、左心室射血分数、左心室侧壁基底部组织收缩期运动速度、舒张早期运动速度及舒张晚期运动速度.结果 室间隔缺损封堵术后3月、6月左心室舒张期末内径、左心室舒张期末容积、左心室收缩期末容积、左心房收缩期末内径、左心室射血分数、左心室侧壁基底部组织收缩期运动速度、舒张早期运动速度及舒张晚期运动速度均较术前1天及术后3天明显减少(P<0.05或0.01),但术后3天与术前1天比较差异无显著性(P>0.05).结论 室间隔缺损封堵术在消除异常分流的同时,可有效改善左心功能及几何形态.     

经导管封堵治疗成人房间隔缺损合并功能性三尖瓣返流

目的 探讨经导管封堵成人房间隔缺损（atrial septal defect, ASD）后能否改善其合并的功能性三尖瓣返流（tricuspid regurgitation, TR）。方法 连续纳入自2019年1月1日～2020年12月31日在空军军医大学西京医院心血管内科经导管封堵的ASD合并功能性TR患者,根据术前超声心动图评估TR严重程度并进行分级,术后6个月进行超声心动图随访,评估功能性TR的改善程度。结果 与合并轻度TR组相比,合并中/重度TR组患者年龄较大（P<0.01）,ASD直径较大,RV直径较大（均P<0.05）,与合并中度TR组相比,合并重度TR组患者年龄较大（P<0.01）,RV直径较大（P<0.05）。封堵前,11例患者合并重度TR,18例患者合并中度TR, 71例患者合并轻度TR;封堵术后6个月,10例患者（91%）由重度TR降至轻度,12例患者（67%）由中度TR降至轻度。所有患者中无轻度TR患者的返流量增加至中度或重度。单变量分析显示,持续性TR与肺动脉直径、右房直径、右室直径、左房直径、左室直径及ASD大小相关。经过多变量分析,以上...     

Role of "buttoned" double-disc device in the management of atrial septal defects.

Sixteen patients seen over a 9-month period ending in August 1990 were offered transcatheter closure of their ASD with a custom-made "buttoned" double-disc device. The study was approved by the Institutional Review Board and informed consent was obtained in each case. The device consists of an occluder, a counteroccluder, and a loading wire and is delivered to the ASD site via an 8F sheath. Parents of two children elected surgical closure. In five children the stretched diameter of the ASD was too large (greater than 20 mm) and transcatheter closure was not attempted. These seven children underwent elective surgical closure without incident. In one child the defect measured 5 mm and the Qp:Qs was 1.4:1 and therefore ASD closure was not recommended. In the remaining eight children transcatheter closure was attempted. In two of the children the occluder pulled through the ASD and was successfully retrieved and the children later underwent uneventful elective surgical closure. The device was implanted across the ASD in six children. In one child the device dislodged from the ASD site within minutes after implantation and the child was sent to emergency surgery, where the device was removed and the ASD was closed. In the remaining five patients, aged 7 months to 45 years (weight 3.6 to 50 kg), with a Qp:Qs range of 1.3 to 2.3 and a stretched diameter of 10 to 19 mm, the ASD closure was successful with 25 to 40 mm size devices. Repeat echo-Doppler studies 2 weeks and 3 months after the procedure in all patients and 6 months later in two children did not reveal any residual shunt. It is concluded that (1) the custom-made "buttoned" double-disc device can be implanted across the ASD safely and effectively via an 8F sheath, thus making transcatheter ASD closure feasible even in very young infants; (2) measurement of stretched diameter of the ASD in the catheterization laboratory is a useful guide for selection of an appropriate-sized device; and (3) additional clinical trials are warranted to confirm the efficacy and safety of the device.     

Changes in Reverse Cardiac Remodeling after Percutaneous Atrial Septal Defect Closure in Children and Adults

Background: The influence of the timing of transcatheter atrial septal defect (ASD) closure on ventricular remodeling at 6 months after ASD closure is unclear. This study investigated changes in cardiac remodeling after transcatheter closure of large ASDs according to patient age at the time of the procedure. Methods: In this study, 41 children and 43 adults underwent percutaneous closure of a large ASD. Cardiac remodeling was assessed by two-dimensional echocardiography and electrocardiography before and at 6 months after ASD closure. Results: The age of the children and adults were 2.8 ± 3.1 and 50.0 ± 15.6 years, respectively. The Qp/Qs ratio of all patients was 2.24 ± 0.67. The right atrial (RA) maximal dimension and right ventricular (RV) transverse diameter were significantly decreased and the left ventricular (LV) dimension was significantly increased at 6 months after ASD closure. However, the difference in RA and RV dimension changes between the groups was not statistically significant. The difference in left atrial (LA) dimension changes between the groups was also not statistically significant, but the LV dimension significantly increased in children compared with that in adults (P = 0.018). The RV/LV ratio was decreased after ASD closure, and a significant difference was found in the RV/LV ratio changes between the groups. In ECG, the PR interval was significantly more decreased in adults than in children (P = 0.003). Conclusions: In conclusion, the LV diameter was significantly more increased in children than in adults at 6 months after percutaneous ASD closure. Thus, cardiac remodeling after percutaneous ASD closure varies in children and adults.