经导管闭合房间隔缺损的疗效观察

我院自 1998年 5月～ 2 0 0 0年 2月应用美国ＡＧＡ公司的双盘片形镍钛合金封堵器成功封堵了房间隔缺损 (房缺 )直径 15～ 36ｍｍ的患者 11例 ,随访 1～ 2 1个月 ,无并发症。1.资料与方法 :(1)临床资料 :11例患者中男性 3例 ,女性 8例 ,年龄 4～ 46 (平均 2 5 .3)岁。术前经临床体检、Ｘ线胸片、多普勒超声心动图检查确诊为先天性心脏病 ,继发孔型房间隔缺损 ,其中 1例于 5年前曾在外院行直视下手术修补术。超声心动图检查测量的房缺孔直径为 12～ 2 8(18.5± 6 .1)ｍｍ ,伴右心室、右心房增大 5例。心电图大致正常 9例 ,心房扑动和心房颤动…     

继发孔房间隔缺损女性妊娠期心血管系统变化

继发孔房间隔缺损占先天性心脏病发病率的第 2位 ,大多数继发孔房间隔缺损女性妊娠过程本身并不复杂 ,然而与妊娠有关的心血管变化可能影响房间隔缺损的血流动力学变化。Piesiewicz等选择 5 4例继发孔房间隔缺损妊娠期女性和 30例正常妊娠期女性 ,观察其妊娠中晚期、产褥期的心功能分级 (NYHA)、心电图、动态心电图和心脏彩超变化 ,从而评定继发孔房间隔缺损女性妊娠期心血管系统变化。结论 :(1)由于入选样本较少和NYHA分级对于妊娠期女性的局限 ,妊娠期心力衰竭与继发孔房间隔缺损的关系并不明确 ;(2 )继发孔房间隔缺损妊娠期女性右房…     

介入封堵房间隔术对患者心率的影响

目的:探讨介入封堵房间隔缺损术对患者心率的影响。方法:选择我院经皮介入封堵房间隔缺损的63例患者,比较手术前后心率的变化,并分析心率与年龄、封堵伞大小以及术前肺动脉压力的相关性。结果:经皮介入封堵房间隔缺损术后心率较术前显著降低[(64.87±10.65)次/min比(75.22±8.23)次/min,P=0.001];Pearson相关分析显示,术后心率变化与年龄、应用封堵伞大小、肺动脉收缩压无关(r=0.017～0.182,P均0.05)。但术前出现肺动脉收缩压升高(≥25mmHg)的患者术后心率下降幅度显著大于术前未出现肺动脉高压患者[(11.35±10.73)次/min比(2.28±9.81)次/min,P=0.038]。结论:经皮介入封堵房间隔缺损术后患者心率会出现下降,术前出现肺动脉高压可作为术后心率下降的风险预测指标。     

先天性心脏病伴肺动脉高压患者血浆内皮素、心钠素的变化及其临床意义

目的 :探讨先天性心脏病患者血浆内皮素 1(ET 1)、心钠素 (ANP)浓度的变化及其临床意义。方法 :对 61例先天性心脏病患者 ,其中伴肺动脉高压 (肺动脉高压组 ) 43例 (其中轻度肺动脉高压 2 5例 ,中度肺动脉高压 9例 ,重度肺动脉高压 9例 ) ;肺动脉压正常 (非肺动脉高压组 ) 18例 ,及 16例健康人 (正常对照组 ) ,用放射免疫法测定血浆ET 1、ANP浓度。结果 :①先天性心脏病伴肺动脉高压患者血浆ET 1、ANP浓度较非肺动脉高压组及正常对照组增高 ,有极显著性差异 (P <0 0 1) ,血浆ET 1、ANP浓度随肺动脉高压程度的加重而升高 ,与肺动脉收缩压呈正相关 (γ =0 88、0 78,P <0 0 1) ;② 39例房间隔缺损患者 ,血浆ET 1、ANP浓度与房间隔缺损大小呈正相关 (γ =0 47、0 40 ,P <0 0 5 ) ;③血浆ANP与ET 1浓度呈正相关 (γ =0 82 ,P <0 0 1)。结论 :先天性心脏病伴肺血流量增加及伴肺动脉高压时 ,显示血浆ET 1、ANP浓度升高。     

房间隔缺损封堵器巧回收1例

患者,女,25岁,既往体健。主因活动后气短2年,加重1周欲行介入治疗入院。体检:BP:110/75mmHg(1mmHg=0·133kPa),无颈静脉怒张,双肺呼吸音清,无干湿音,心率80次/min,律齐,A2相似文献   

影响儿童继发孔型房间隔缺损肺动脉压力的因素

目的 探讨儿童继发孔型房间隔缺损（ASD）肺动脉压力的影响因素.方法 回顾性分析2000年4月至2011年1月沈阳军区总医院收治的10岁以下继发孔型ASD患者,全部患儿在氯胺酮全麻下行心导管检查测肺动脉压力,并完成封堵治疗.收集患者性别、年龄、身高、体重及体表面积、ASD直径、心胸比值和肺动脉收缩压、舒张压、平均压,术后超声心动图随访1年,并按缺损直径和年龄分组.结果 本研究共359例患儿,男130例（36.2％）.平均年龄（5.8±2.2）岁（2～10岁）,平均体重（21.0±7.1） kg （10～57kg）,平均缺损直径（13.6±5.6） mm（5～30 mm）,体表面积矫正缺损直径为（17.0±7.1） mm/m2（1.3～41.0 mm/m2）,平均肺动脉收缩压（40.8±8.7 mmHg） （15～67 mmHg）（1 mmHg=0.133 kPa）.318例（88.6％）患者心导管测量存在肺动脉高压,所有患者术前及术后1、3、6、12个月超声估测肺动脉压均正常;肺动脉压力不随房间隔缺损直径增大而升高（P＞0.05）;10岁以下儿童肺动脉压力与年龄和体表面积矫正的缺损直径无相关性（P＞0.05）.结论 10岁以下继发孔型ASD患儿,心导管检查所测肺动脉压力与患儿年龄和体表面积矫正的缺损直径无关,与缺损直径无简单线性关系,压力不随缺损直径增大而升高.     

巨大房间隔缺损介入封堵治疗的可行性和安全性评价

目的:分析我院治疗的12例巨大房间隔缺损(ASD)患者,评估其介入治疗的疗效及安全性. 方法:12例患者均为继发孔型ASD,其中男性5例,女性7例,年龄(36.3±10.6)岁,超声测量ASD缺损直径平均为(33.1±4.5)mm.4例患者心房顶部残端<3 mm或边缘菲薄,3例患者主动脉部位的残端<3 mm或缺如;肺动脉平均压力(36.2±13.1)mm Hg,中度以上肺动脉高压7例;心脏显著扩大者6例.均应用国产封堵器,封堵器直径36～42 mm.术后1周、3、6、12个月行胸片、心电图、心脏彩超随访.结果:12例患者均采用右上肺静脉释放法,10例手术成功,2例缺损直径>40 mm者手术失败,手术成功率为83.3%.2例患者术后超声检查显示有少量残余分流,术后1周残余分流消失.1例心房顶部残端<3 mm患者术后1 d封堵器脱落,行急诊外科手术.术后3个月～6年的随访中,5例肺动脉高压患者术后3个月内肺动脉压力均显著下降,6例心脏显著扩大者心脏均明显缩小.所有患者均无房水平的分流,未发现栓塞性疾病、感染性心内膜炎、传导系统异常、偏头痛等并发症.无死亡病例. 结论:介入治疗巨大房间隔缺损安全、有效,但应该注意适应证的选择和术后监测.     

常见先天性心脏病的临床诊断

<正> 先天性心脏病系临床上较为常见的一类心脏病,仅次于风心病和缺血性心脏病。儿童发病率高于成人,大多数常见先心病可获得明确诊断及手术矫正。先心病的分类一、无分流畸形有肺动脉瓣狭窄(肺狭),原发性肺动脉高压,原发性肺动脉扩张,主动脉瓣狭窄,主动脉缩窄等。二、左向右分流畸形有房间隔缺损(房缺),室间隔缺损(室缺),动脉导管未闭,主动脉窦瘤破裂,冠状动脉瘘等。三、右向左分流畸形有法乐氏四联症,三联症(重度肺狭十房缺),三尖瓣闭     

超声心动图在经导管房间隔缺损封堵术中的应用进展

房间隔缺损（ASD）是成人最常见的先天性心脏病,发病率约占所有先心病患者的10%～30%,其中70%为继发孔型房间隔缺损（SASD）。对有明显左向右分流的房缺和（或）伴随明显症状和心脏扩大的房缺,必须选择房间隔封闭术。虽然外科修补术技术成熟，疗效确定，但存在一些与手术相关的并发症。     

保守疗法治愈室间隔缺损残余漏修补术后再漏一例

室间隔缺损(室缺)修补术后残余漏是常见的并发症之一,而残余漏修补术后再漏较少见.由于残余漏的位置及大小不同,其临床表现与治疗各异.最近,我们采用保守疗法成功地治疗1例房间隔缺损(房缺)合并室缺、重度肺动脉高压,行缺损修补术后发生残余漏再补再漏的患儿.现介绍如下.     

Natural histories of atrial septal defect with pulmonary hypertension, and ventricular septal defect with pulmonary hypertension

A study of the natural history of 51 adult patients with atrial septal defect with pulmonary hypertension (ASD + PH) was performed. ASD + PH of less than 14 Um2 of pulmonary artery resistance (PVR) was considered an indication for surgery. The prognosis of surgically treated patients was favorable, but that of medically treated patients was poor. For patients with ventricular septal defect with pulmonary hypertension (VSD + PH), surgery was considered for pulmonary-systemic vascular resistance ratio (Rp/Rs) less than 0.5, and for patients under than 10 years and, ideally, under 2 years of age.     

Gene polymorphisms of endothelial nitric oxide synthase enzyme associated with pulmonary hypertension in patients with COPD

In this cross-sectional controlled study, we aimed to investigate the role of polymorphisms of the angiotensin-converting enzyme (ACE) and endothelial nitric oxide synthase (eNOS) genes on pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD). Forty-two (41 male, 1 female, mean age: 62 +/- 7 years) COPD patients and 40 (all male, mean age: 60 +/- 8 years) healthy controls were included. Respiratory function tests, arterial blood gases, and echocardiographic examinations were performed. ACE and eNOS genotypes were determined using PCR. The ACE and eNOS genotype distribution was not significantly different between COPD patients and controls. On comparing pulmonary artery pressures in different eNOS genotypes, the mean pulmonary artery pressure (Ppa) in patients with the BB genotype was significantly higher than in patients with the nonBB genotypes (41.3 +/- 17.7 mmHg vs. 27.3 +/- 11.2 mmHg, P = 0.02). However, there was no difference in ACE genotype distributions between COPD patients with and without pulmonary hypertension. In stepwise linear regression analysis for predicting pulmonary artery pressure, PaO2 and polymorphism of eNOS gene were found to be independent variables. In conclusion, BB-type polymorphism of the eNOS gene has been associated with PH in addition to hypoxemia. However, ACE gene polymorphism was not found to be associated with PH.     

彩色多普勒血流显像对心房间隔缺损诊断的评价

目的：探讨彩色多普勒超声心动图诊断心房间隔缺损的临床价值。方法：以彩色多普勒血流显像技术对７５例患者的心房间隔缺损定位及估测缺损大小，并测定肺动脉收缩压。结果：７５例患者中，５２例经手术证实。彩色多普勒超声心动图诊断心房间隔缺损的敏感性达１００％；对缺损的定位准确率为９４．２％（４９／５２）；对缺损大小的估测与手术结果呈显著正相关（ｒ＝０．９５，Ｐ＜０．００１）。对Ｍ型超声心动图显示疑有肺动脉高压的２３例患者用三尖瓣反流压差法估测的肺动脉收缩压与心导管测值密切相关（ｒ＝０．８８，Ｐ＜０．００１）；同时计算肺动脉与主动脉根部内径比值与心导管测值比较，发现肺动脉与主动脉根部内径比值≥１．３５，提示肺动脉高压。结论：彩色多普勒超声心动图对心房间隔缺损有术前诊断价值，并能评价手术效果，可替代有创性检查。     

Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality

OBJECTIVES: We sought to determine the predictors of short-term morbidity and mortality (< 30 days) after noncardiac surgery in patients with pulmonary hypertension (PH). BACKGROUND: Pulmonary hypertension is considered to be a significant preoperative risk factor. METHODS: The PH and surgical data bases were matched from 1991 to 2003. Patients were excluded if PH was secondary to left heart disease, not present before surgery, or the procedure involved cardiopulmonary bypass. Univariate and multivariate logistic regression analyses were used to identify variables associated with short-term morbidity and mortality. RESULTS: Of 1,276 patients in the PH database, 145 patients (73% female) met all study criteria. The mean age (+/-SD) was 60.1 +/- 16.0 years. Right ventricular systolic pressure (RVSP) (mean +/- SD) on the two-dimensional echocardiogram was 68 +/- 21 mm Hg. There were 60 patients (42%) who experienced one or more short-term morbid event(s) (1.8 events/patient experiencing any event). A history of pulmonary embolism (p = 0.01), New York Heart Association functional class > or = II (p = 0.02), intermediate- to high-risk surgery (p = 0.04), and duration of anesthesia > 3 h (p = 0.04) were independent predictors of short-term morbidity. There were 10 early deaths (7%). A history of pulmonary embolism (p = 0.04), right-axis deviation (p = 0.02), right ventricular (RV) hypertrophy (p = 0.04), RV index of myocardial performance > or = 0.75 (p = 0.03), RVSP/systolic blood pressure > or = 0.66 (p = 0.01), intraoperative use of vasopressors (p < 0.01), and anesthesia when nitrous oxide was not used (p < 0.01) were each associated with postoperative mortality. CONCLUSIONS: In patients with PH undergoing noncardiac surgery with general anesthesia, specific clinical, diagnostic, and intraoperative factors may predict worse outcomes.     

Pulmonary hypertension and thyroid disease

BACKGROUND: The association between thyroid dysfunction and pulmonary hypertension (PH) has not been well characterized. METHODS: This retrospective study comprised 356 consecutive PH patients seen at Mayo Clinic Jacksonville Pulmonary Hypertension Center from 1992 to 2006 and 698 sex-matched control subjects without PH. Thyroid disease was defined as an abnormal thyroid-stimulating hormone level, with or without an abnormal free or total thyroxine level, a history of thyroid disease on replacement, or an elevated thyroperoxidase antibody level. The main outcome measure was prevalence of thyroid disease in each group. RESULTS: Median age of the 356 PH patients was 65 years; 230 patients (65%) were female. The control group of 698 patients had the same sex ratio and median age of 68 years. Most PH patients had severe PH, as categorized by World Health Organization (WHO) class (74% class 3-4) and pulmonary artery systolic pressure. Among those with PH, 85 patients (24%) had thyroid disease vs 107 control patients (15%). After adjusting for age and sex, the prevalence of thyroid disease was increased in PH patients compared with control patients. Increased prevalence was most prominent in WHO group 1, pulmonary artery hypertension confirmed by right-heart catheterization (odds ratio, 2.53; 95% confidence interval, 1.55 to 4.08; p < 0.001). Most patients had mild thyroid disease and were hypothyroid. Only 14 of 85 patients (16%) had previously undiagnosed thyroid disease. CONCLUSIONS: Patients with PH have a higher prevalence of thyroid disease than other pulmonary patients. Evaluation of thyroid function in PH patients may be warranted to detect and assess coexisting thyroid disease.     

Coronary arteriographic findings in the patients with atrial septal defect and pulmonary hypertension (ASD + PH)--compression of left main coronary artery by pulmonary trunk

The characteristic narrowing of left main coronary artery (LMCA) was found in 44% of patients (pts) with atrial septal defect and pulmonary hypertension (ASD + PH). The cause of the narrowing is thought to be the compression by pulmonary trunk (PT). Cardiac catheterization and coronary arteriography (CAG) were performed in 38 pts with ASD ranging in age from 15 to 62 years. We defined abnormal narrowing as 50% or more stenosis of AHA classification. Sixteen pts (42%) had PH, and of these pts 7 show the abnormal narrowing of LMCA. (18% of all pts with ASD, 44% of pts with ASD + PH). They had no signs of syphilis or aortitis. Of the pts with PH, those with abnormal LMCA revealed higher pulmonary artery mean pressure than those with normal LMCA (43.6 +/- 17.3 and 27.1 +/- 5.5 mmHg respectively. p less than 0.01). Other parts of coronary arteries are intact in all pts. These findings suggest that the LMCA abnormality relates to PH. In all cases with LMCA abnormality the narrowing revealed some special features indicate the cause of narrowing is compression. First, the most severe part of narrowing was the coronary ostium, and severity reduced gradually as distal LMCA. Second, the narrowing was estimated most severely in the view of LAO 20, but almost normal in the view of RAO 30. This finding suggests the narrowing is ellipsoid. Third, the shape of LMCA changed in the different phase of cardiac cycle. In the systole, the cranial border of LMCA was convex, but in the diastole it was concave. This indicates LMCA was soft and compressed.(ABSTRACT TRUNCATED AT 250 WORDS)     

房水平单向活瓣式补片在先天性心脏病并发重度肺动脉高压术中的应用

目的:探讨并发重度肺动脉高压的先天性心脏病患者的外科手术方式。方法: 采用房水平单向活瓣补片对48例本病患者进行手术治疗。其中,室间隔缺损30例,房间隔缺损3例,室间隔缺损并发房间隔缺损8例,室间隔缺损伴动脉导管未闭7例。结果: 术后1例（2%）死于低心排综合征。术后早期均有明显低氧血症。术后1周仍出现跨单向活瓣补片分流40例,术后3个月活瓣仍开放10例,术后26个月提示活瓣均关闭,分流消失,经皮血氧均为95%以上,肺动脉压均明显下降。结论: 房水平单向活瓣式补片治疗先天性心脏病并发肺动脉高压,使患者度过术后危险期,提高手术成功率。     

房间隔缺损封堵术后应用重组人脑钠尿肽的疗效观察

目的:探讨重组人脑钠尿肽(recombinant human brain natriuretic peptide,rhBNP)对房间隔缺损(ASD)并发肺动脉高压封堵术后的肺动脉高压的影响。方法:选择56例房间隔缺损并发中重度肺动脉高压患者封堵成功患者,将其随机分为术后静脉点滴rhBNP患者为处理组(30例),未应用的为对照组(26例),比较两组术前、术后48 h及术后6个月肺动脉压、6分钟步行试验距离(six minute walking distance,6MWD)、血浆内皮素(endothelin,ET)水平的变化。结果:在术后48 h和术后6个月,两组患者肺动脉压及ET水平术后明显降低(P<0.05);两组患者6MWD较术前显著增加(P<0.05);术后48 h和术后6个月处理组较对照组显著降低肺动脉压及ET水平(P<0.01),显著增加6MWD(P<0.01)。结论:封堵术后静脉点滴rhBNP可进一步降低肺动脉压及ET水平,增加6MWD。     

四种超声心动图技术评价正常人心肌生物力学参数及其与心功能相关关系

目的: 比较直接二维测量法(D2D)、解剖M型(AMM)、组织速度成像技术(TVI)及二维斑点追踪技术(STI)评价正常人心肌生物力学参数及其与心功能相关关系的方法,比较他们在临床运用过程优点及存在问题。方法: 分别应用D2D、AMM、TVI及STI测量并比较40例正常人收缩、舒张期心肌在长轴方向、短轴和圆周方向的心脏生物力学参数。结果: D2D显示:正常人收缩期纵向应变(LS)及应变率(LSR):下壁>后间隔>前间隔>后壁>前壁>侧壁（P>005）;收缩期LS、LSR与左室射血分数（LVEF）相关系数(r)分别为-0523及-0550。AMM显示:正常人收缩末期径向应变(RS)及径向应变率(RSR)游离壁大于间隔:收缩期RS、RSR与左LVEF(r)分别为0533及0495。TVI显示:收缩期LS:心尖段<基底段、中间段(P<005);舒张早期LS中间段>基底段>心尖段;舒张晚期LS心尖段<基底段、中间段(P<005);收缩期LS、LSR与LVEF(r)分别为-0562及-0550。STI显示:收缩期LS从基底段到心尖段逐步递增;左室扭转运动表现为心底部顺时针旋转和心尖部逆时针旋转,心脏整体表现为心动周期内逆时针方向为主的扭转运动。心肌收缩期平均LS及LSR与左室收缩功能参数间r的绝对值均超过055。结论: D2D通过直接测量左室长轴方向心肌长度的变化,间接计算LS与LSR;AMM克服了M型超声测量的角度限制,比较适合体位不合作的患者;TVI适合评价长轴方向室壁运动特征;STI对二维图像的超声斑点回声进行逐帧追踪,可以更准确测量局部室壁V、S等参数,定量评价局部心肌的收缩和舒张功能,测量参数与传统超声测量LVEF相关性较好,但设备要求较高。     

Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD.

Studies have confirmed the close correlation of echocardiographically estimated pulmonary arterial pressure with invasive measurements in patients with chronic obstructive pulmonary disease (COPD), but there are few data on utility of echocardiographic measurement in assessing pulmonary arterial hypertension (PH) in COPD and correlation with pulmonary function tests. Presence or absence of tricuspid regurgitation (TR) was determined by Doppler echocardiography in 73 consecutive COPD patients attending a hospital outpatient clinic. Transtricuspid pressure gradient (TTPG) was calculated. PH was defined as TTPG > or =30 mmHg. Patients also underwent spirometry, forced expiratory volume in one second (FEV1), single breath gas transfer (carbon monoxide transfer coefficient; (K(CO)) and carbon monoxide diffusing capacity of the lung; D(L,CO)) and arterial blood gas measurement. Measurable TR was observed in 56/73 patients (77%). There were no differences between the group in which TR was observed compared to that in which it was absent, with regard to age, smoking history nor pulmonary function variables. PH was seen in 31/56 cases (55%), with good reproducibility. There were statistically significant correlations of TTPG with FEV1 (r=-0.26, p=0.05), Kco (r=-0.31, p=0.04) and D(L,CO) (r = -0.42, p = 0.006) expressed as % pred. Stepwise regression analysis showed that age and K(CO) combined provide a multivariate model for prediction of TTPG. It is concluded the presence and degree of pulmonary arterial hypertension is readily and reliably determined by echocardiography in the majority of chronic obstructive pulmonary disease patients. Pulmonary arterial hypertension is common in severe chronic obstructive pulmonary disease and transtricuspid pressure gradient correlates with spirometry and indices of gas transfer, similar to previous invasive studies. In view of the adverse effects of pulmonary arterial hypertension on morbiditv and mortality routine echocardiography in patients with severe chronic obstructive pulmonary disease may be warranted.