国产封堵器介入治疗房间隔缺损后右心形态和功能的变化

目的:评价国产封堵器介入治疗房间隔缺损（ASD）后右心形态和功能的变化规律。方法:患者41（男15,女26）例,经胸超声（TTE）示ASD最大径5～34（19.4±7.4）mm,选用封堵器型号为8～44（25±9）mm.。术后即刻、2d、3和6月行TTE追踪测量及随访。心尖四腔切面面积—长度法计算右心室容积及射血分数。结果:房缺封堵术后2d及3月随访,右心房上下径、左右径,舒张末期右心室前后径、左右径均进行性减小,与术前比较有显著差异（P<0.05,P<0.01）。术后2d右心室的舒张末期容积较术前明显减小（P<005）,右室射血分数逐渐趋于正常。3月右心室的舒张末期容积、收缩末期容积和射血分数进一步改善。3～6月右心房、室大小基本恢复正常。结论:国产封堵器封堵ASD后右心形态和功能的变化规律与Amplatzer封堵器引起的相一致,即在消除异常分流的同时,有效改善右心室容量负荷状态和右心系统的几何构型。     

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。     

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     

房间隔缺损封堵术对左心形态和功能的影响

目的　观察继发孔型房间隔缺损 (ASD)患者经导管置入Amplatzer封堵器术后对左心形态和功能的影响。方法　对 5 0例继发型ASD患者 ,年龄 16～ 70 (39 2 4± 14 77)岁 ,其中男性 16例、女性 34例 ;房间隔缺损大小为 9～ 35 (2 1 85± 11 6 5 )mm ,在透视及经食管超声心动图 (TEE)监视下经导管置入Amplatzer封堵器 ,术前、术后 2 4h、术后 1个月及 6个月分别行经胸超声心动图 (TEE)检查。结果　 5 0例患者均置入成功 ,术前左心功能NYHA分级Ⅱ级有 11例、Ⅲ级有 2例 ,术后 1个月心功能Ⅱ级 4例 ,术后 6个月为 1例。术后 2 4h开始 ,左心室舒张末期前后径、横径开始增加 ,但差异无显著性 (P >0 0 5 ) ;术后 1个月、6个月随访、观察明显增加 (P <0 0 1)。左心室每搏输出量及射血分数增加 (P <0 0 5或P <0 0 1) ,但左室缩短率无变化 (P >0 0 5 ) ;二尖瓣口E峰流速明显增加 (P <0 0 1) ,而左心室舒张末期长径、左心房横径及左右径变化不明显。结论　继发型ASD患者经导管置入Amplatzer封堵器术后左心室收缩及舒张功能明显改善。     

经胸超声心动图指导儿童房间隔缺损封堵术

目的 :评价经胸超声心动图 (TTE)在术前测量房间隔缺损 (ASD)大小、术中监测与指导儿童ASD封堵的作用。方法 :10例ASD儿童采用TTE多个切面综合判断ASD大小、周缘情况及房间隔伸展径。比较ASD之TTE测值与封堵成功所选用的封堵器大小之间的关系。在封堵术中TTE监测封堵过程、伞释出后牢固程度及彩色多普勒有无分流。结果 :ASD的TTE测值为 8～ 2 4 (15 .8± 5 .9)mm ,封堵器型号为 8～ 2 8(18.8±6 .0 )mm ,TTE测量的ASD大小与封堵器大小相关良好 ,直线方程Y =4 .36 0 +0 .914X ,相关系数r =0 .90 5(P <0 .0 1)。硬缘ASD的封堵器选择比TTE所测ASD大 1～ 5mm ;封堵器型号的选择多在球囊测值的基础上加 0～ 2mm。所有封堵器牢固 ,无脱落。结论 :TTE封堵术前检查和术中指导ASD封堵器的放置是一种可行、有效、简便的方法     

中老年继发孔型房间隔缺损经导管封堵术后左、右心功能变化

目的:探讨中老年继发孔型房间隔缺损(ASD)经导管封堵术后左、右心功能变化。方法:观察269例接受封堵治疗的40岁以上ASD患者术前和术后X线胸片、经胸超声心动图(TTE)和心电图变化。另选择同期30例健康查体的相同年龄和性别构成比对象作为超声指标的正常对照。结果:全组缺损TTE最大径平均17．7±5．3(5～30)mm,选用封堵器直径平均27．5±6．0(13～40)mm。心功能术后1天较术前、术后1个月较术后1天改善,有显著性差异(P<0．05～0．001)。心胸比率术后1天较术前、术后6个月较术后1个月缩小,有显著性差异(P<0．05～0．001)。心电图:右心房高负荷率、RV1+SV5、QRS间期、右束支传导阻滞比率术后1天较术前、术后1个月较术后1天,均有显著性差异(P<0．05～0．001)。超声心动图:右心室前后径,术后1天较术前、术后1个月较术后1天、术后6个月较术后1个月缩小,均有极显著性差异(P<0．01～0．001);主肺动脉内径术后1天较术前缩小,但术后6个月仍高于正常对照,有极显著性差异(P<0．001)。三尖瓣反流程度分级术后1天较术前、术后1个月较术后1天,均有显著性差异(P<0．05～0．001)。左心房前后径术前、术后无显著性变化。左心室舒张末期内径术后1天较术前、术后1个月较术后1天、术后6个月较术后1个月增加,均有极显著性差异(P<0．01～0．001),左心室射血分数术后1天较术前增加,有极显著性差异(P<0．001)。结论:封堵治疗能够有效降低中老年ASD右心内径和肺动脉收缩压,增加左心室内径,改善左心室收缩功能和心室电传导。近中期疗效满意,远期疗效有待于进一步观察。     

经导管介入封堵及外科修补术对房间隔缺损患者右室收缩及舒张功能的影响

目的比较经导管介入封堵及外科修补术对房间隔缺损(ASD)患者右心室收缩及舒张功能的影响。方法 43例接受介入封堵术(介入封堵组)及41例接受外科修补术的继发孔型ASD患者(房缺修补组),于术前及术后7 d、3个月分别进行经胸超声心动图(TTE)及实时三维超声心动图(RT-3D-TEE)检查,测量其右室舒张末期前后径(RVEDD)、右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室收缩峰压(RVSP)、右室面积变化分数(RVFAC)及三维右室射血分数(3DRVEF),采用脉冲波多普勒显像技术测量三尖瓣血流频谱(E/A)和组织多普勒血流显像技术(TDI)测量三尖瓣环频谱(E'/A'),并计算E/E'值。结果术后7 d,介入封堵组RVEDD、RVEDV、RVESV及RVSP均较术前明显减小(P0.05);而RVFAC及3DRVEF、E/A、E'/A'及E/E'与术前无显著差异;房缺修补组RVEDD、RVEDV、RVESV、RVSP、RVFAC、3DRVEF、E/A、E'/A'较术前明显减小(P0.05);而E/E'较术前增高(P0.05);术后3个月,两组RVFAC、3DRVEF、E/A、E'/A'较术前增高(P0.05),E/E'较术前降低(P0.05)。结论与房间隔缺损外科修补相比,介入封堵对右心室早期的收缩及舒张功能影响较小,有利于ASD患者右心功能的早期恢复。     

慢性房颤消融术后左房和左室结构的远期变化

目的 观察维持窦律对慢性房颤射频消融术后患者左房和左室结构的影响。 方法 入选38例慢性房颤行射频消融术的患者，分别于术前、术后1年行超声心动图检查, 测量左房前后径、左房上下径、左房左右径、左房最大容积、左室舒张末内径、左室收缩末内径，左室射血分数，评估房颤有无复发对左房及左室重构的影响。 结果 31例慢性房颤病人完成随访，随访时间为12-16个月，将其按消融效果分为复发组（15例）和非复发组（16例）。随访结果如下：(1)复发组慢性房颤射频消融术前左房前后径、左房上下径、左房左右径、左房最大容积、左室舒张末内径、左室收缩末内径、左室射血分数与非复发组术前比较，差异无统计学意义（P>0.05）。(2)复发组慢性房颤射频消融术后12个月左房前后径、左房上下径、左房左右径、左房最大容积、左室舒张末内径、左室收缩末内径、左室射血分数与术前相比较，差异无统计学意义（P>0.05）；(3)复发组慢性房颤射频消融术后12个月左房前后径、左房上下径、左房左右径、左房最大容积、左室舒张末内径、左室收缩末内径比术前减小，左室射血分数比术前增加，差异具有统计学意义（P<0.05）。     

超声心动图评价房间隔继发孔缺损封堵术后心脏结构及功能的变化

目的探讨超声心动图评价房间隔缺损(ASD)介入封堵术后心脏结构和功能的变化。方法抽取2011年1月-2013年8月在我院经超声心动图检查确诊为ASD并成功施行ASD封堵术的患者56例,年龄(34.63±12.64)岁,ASD直径为(17.39±6.12)mm。于封堵器封堵术后3 d、3个月、6个月进行经胸超声心动图追踪测量左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、右心室前后径(RVEDD)、右房横径(RAD)和左室射血分数(LVEF),并将这56例患者在术前、术后及随访过程中所测得的指标作对照研究,并进行统计学分析。结果 1与术前比较,LVEDD、LVESD、LAD在术后3 d及术后3个月逐渐增大,RVEDD、RAD在术后3 d及术后3个月逐渐减小,差别有统计学意义(P0.05)。2各项指标在术后6个月的随访中无进一步变化,趋于稳定(P0.05)。3LVEF在术后3 d略有增加,术后3个月及6个月无变化,但与术前比较,差别均无统计学意义。结论 ASD介入封堵术既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结构。     

经冠状动脉注射自体骨髓干细胞治疗扩张型心肌病8例

目的探讨经导管冠状动脉内注射自体骨髓干细胞(bone marrow stem cells,BMSc)对扩张型心肌病(dilated cardiomyopathy,DCM)治疗的有效性及安全性。方法选择2003年12月-2004年11月我科住院扩张型心肌病患者共8例,其中男5例,女3例,年龄47-72岁。冠状动脉造影排除冠心病后,经导管将已提取单个核细胞的自体BMCs悬液30ml分3次,每隔10分钟,经左冠状动脉注入。移植前及移植后1,2,4,8,16个月进行6分钟步行试验、用超声心动图检查:包括左心室收缩期末内径及舒张期末内径:左心室收缩期末容积和舒张期末容积,计算左心室射血分数、室间隔及左室前壁厚度。治疗前后同时常规使用其他治疗扩张型心肌病药物。结果在术中及术后近期,所有患者均无心功能恶化表现及其他不良反应。随访1个月,患者6分钟步行试验达(352±61)m,而术前仅(301±54)m,差异有统计学意义(P<0.05);左心室射血分数从术前(34.6±5.1)%升高到(42.8±4.7)%,差异有统计学意义。左心室收缩期末内径;左心室舒张期末内径、左心室收缩期末容积、舒张期末容积与术前相比无明显变化。随访1～18个月,患者自觉症状较前缓解,无明显并发症发生。结论经导管冠状动脉内注射自体BMCs治疗扩张型心肌病有一定的疗效,能被患者耐受。     

中老年心房间隔缺损患者经导管封堵术后心功能变化

目的　探讨 40岁以上心房间隔缺损患者用导管封堵术治疗后的心功能变化。方法　采用封堵术治疗 2 1例40岁以上心房间隔缺损患者 ,并于术后 6个月进行随访 ,观察心脏彩超和心电图所得结果与术前比较。结果　心房间隔缺损封堵术后 6个月 ,心脏彩色多谱勒超声提示心脏收缩末期右房最大容积和右室舒张末期容积显著降低 ;左室舒张末期容积、射血分数和左室短轴缩短率显著提高 ;心电图提示PR间期和QRS宽度明显缩短。结论　40岁以上心房间隔缺损患者行心房间隔封堵术能够降低右心室的容量负荷 ,提高左心室的收缩功能 ,改善心房和心室的电传导     

Cardiac resynchronization therapy for heart failure induced by left bundle branch block after transcatheter closure of ventricular septal defect

A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly （155 m）. Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.     

Right and left ventricular volume characteristics in children with transposition of the great arteries after Mustard's procedure

With use of biplane cine-angiocardiograms, the measurements of right and left ventricular volume were determined in 11 children with transposition of the great arteries following Mustard's procedure. Right ventricular end-diastolic volume (RVEDV) ranged from 124 to 264 percent of the normal right ventricular volume with an average of 188 +/- 40 (SDM) percent, and left ventricular end-diastolic volume (LVEDV) ranged from 57 to 181 (122 +/- 43) percent of the normal (p less than 0.01, vs. RVEDV). Right ventricular ejection fraction (RVEF) ranged from 0.26 to 0.66 (0.42 +/- 0.11), and left ventricular ejection fraction (LVEF) ranged from 0.51 to 0.79 (0.66 +/- 0.09) (p less than 0.001, vs RVEF). Left ventriculography showed a deviation of the interventricular septum toward the left ventricle in patients with simple transposition of the great arteries not associated with left ventricular hypertension. The left to right ventricular systolic pressure ratio ranged from 0.22 to 1.02 (0.48 +/- 0.28), and the left to right ventricular end-diastolic volume ratio ranged from 0.43 to 1.00 (0.63 +/- 0.18). There was a high correlation between the left to right ventricular systolic pressure ratio and the left to right ventricular end-diastolic volume ration (r = 0.94, p less than 0.001). The left to right ventricular systolic pressure ratio also correlated well with the right ventricular ejection fraction (r = 0.90, p less than 0.001). Deviation of the interventricular septum was considered to result in a diminished ejection fraction of the right ventricle, in patients with simple transposition of the great arteries not associated with left ventricular hypertension, after Mustard's procedure.     

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.     

Cardiac performance in total anomalous pulmonary venous connection]

Cardiac performance in 54 patients with total anomalous pulmonary venous connection was investigated by cardiac catheterization before and after surgery. 51 patients underwent intracardiac repair, and 17 of them died during or immediately after operation. According to the preoperative study, the left ventricular ejection fraction (LVEF) of surviving patients was significantly higher than that of patients who died, and the pulmonary arterial mean pressure of surviving patients was significantly lower than that of patients who died. However, there was no significant difference between the left ventricular end-diastolic volume (LVEDV), right ventricular ejection fraction (RVEF), and right ventricular end-diastolic volume (RVEDV) in surviving patients and those who died. Post-operative catheterization studies showed significant increases of LVEF and LVEDV compared to pre-operative figures. RVEF and RVEDV and pulmonary arterial mean pressure decreased significantly after surgery. It was concluded that preoperative cardiac performance of surviving patients was better than that of those who died, and post-operative cardiac performance of surviving patients was basically normal.     

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)