重组人脑钠肽对动脉导管未闭封堵术后肺动脉高压的影响

目的:研究静脉应用重组人脑利钠肽(rhBNP)对经皮动脉导管未闭封堵术后患者肺动脉高压的影响.方法:36例动脉导管未闭封堵术后患者,随机分为处理组16例和对照组20例,处理组于封堵术后即刻静脉应用rhBNP,48 h后比较2组封堵术前后肺动脉收缩压和肺动脉平均压.结果:2组患者肺动脉收缩压和肺动脉平均压明显低于封堵术前水平(P<0.00);处理组肺动脉收缩压和肺动脉平均压明显低于对照组(P<0.05).结论:动脉导管未闭患者封堵术后应用rhBNP可进一步降低肺动脉压.     

老年房间隔缺损患者介入治疗的临床分析

目的 探讨老年房间隔缺损患者的临床特征及行经导管封堵治疗的安全性和有效性.方法 入选2000年5月至2010年6月行经导管封堵治疗的(64.5±3.8)岁房间隔缺损患者82例.经导管封堵术中行右心导管检查.术后1d、1个月、3个月和6个月进行随访.分析老年房间隔缺损患者的临床特征,观察房间隔缺损封堵前后肺动脉压及心功能的改变情况.结果 82例房间隔缺损患者中,合并肺动脉高压37例,发生率为45.1％.封堵前的右心导管检查显示,患者肺动脉收缩压为(44.1±12.4)mm Hg(1 mm Hg=0.133 kPa),肺动脉平均压为(25.2 +6.8)mm Hg.1例重度肺动脉高压患者不适宜经导管封堵治疗,其余81例均成功行介入治疗,无手术相关并发症.36例封堵成功的肺动脉高压患者肺动脉收缩压由术前的(52.7±10.3)mm Hg下降至术后的(31.8 +6.3)mm Hg(P＜0.05),肺动脉平均压由术前的(30.9±4.7) mm Hg下降至术后的(21.8±3.4) mm Hg(P＜0.05).与术前比较,术后1d、1个月、3个月和6个月NYHA心功能分级改善.术后新发心房颤动6例.结论 老年房间隔缺损患者通常合并肺动脉高压.只要严格掌握适应证和规范操作,经导管封堵治疗老年房间隔缺损仍是一种安全有效的方法.     

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。     

微创非体外循环房间隔缺损封堵术的临床应用

目的总结我院微创非体外循环房间隔缺损封堵术的临床应用经验。方法对10例继发孔型房间隔缺损(ASD)患者进行微创非体外循环房间隔缺损封堵术。全麻下右侧胸骨旁第4肋间4-6cm切口,食管超声(TEE)测量房间隔缺损最长径,选择适当封堵伞,TEE监测下释放封堵伞,了解有无残余分流等异常。结果10例患者手术均成功,术中未发生任何并发症,术后复查心彩超未见残余分流。2例出现术后高血压,给与降压对症治疗,1例中度肺动脉高压复查心彩超肺动脉压明显下降,术后右心大小较术前有减小。结论微创非体外循环房间隔缺损封堵术是一种微创手术治疗方法,值得推广、发展。     

高海拔地区动脉导管未闭并发肺动脉高压的介入治疗

目的:评估高海拔地区动脉导管未闭(PDA)并发肺动脉高压介入封堵术的临床疗效。方法:6例PDA并发肺动脉高压患者均采用介入封堵术,术前均行右心导管检查,监测肺动脉压、主动脉压,首先试堵PDA,连续动态监测肺动脉压,只有在肺动脉压下降60%后,才能完全封堵PDA并释放封堵器,并给降压治疗,以巩固疗效。结果:6例PDA并发肺动脉高压患者均一次封堵成功,肺动脉压平均下降68%,动脉血氧饱合度提高,患者自我感觉良好,随访28d~27个月,患者活动量增加,心功能恢复至1~2级。结论:介入封堵治疗PDA并发肺动脉高压安全、有效,近期临床疗效满意,长期疗效有待进一步观察研究。     

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。     

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。     

动脉导管未闭合并重度肺动脉高压Amplatzer法封堵治疗的临床应用--12例初步报告

目的评价Amplatzer封堵器治疗动脉导管未闭(PDA)合并重度肺动脉高压(SPH)的初步疗效.方法对12例(女9例,男3例)PDA合并SPH患者实施封堵治疗.其中10例采用Amplatzer动脉导管未闭封堵器,2例采用Amplatzer房间隔缺损封堵器.结果全组12例PDA封堵器均放置成功.11例PDA封堵后30分至1小时肺动脉收缩压、肺动脉平均压均明显降低.1例封堵术后即刻肺动脉压无变化.术后36小时彩色多普勒估测肺动脉压明显下降,封堵术后30分降主动脉造影,无残余分流9例,微量残余分流2例,少量残余分流1例.全组术后24～48小时彩色多普勒检查,动脉水平左向右分流均完全消失.无重要并发症发生.随访1～24个月(平均8个月),患者症状改善,11例心脏缩小,无1例发生再通.结论采用Amplatzer法封堵治疗PDA合并SPH,近期疗效满意.     

经导管置入Amplatzer封堵器治疗房间隔缺损前后血浆内皮素、一氧化氮、心钠素水平变化及意义

目的:探讨经导管置入Amplatzer封堵器治疗房间隔缺损前、后血浆内皮素1(ET-1)、一氧化氮(NO)、心钠素(ANP)水平变化。方法:22例房间隔缺损患者,按有、无肺动脉高压分为肺动脉高压组14例,无肺动脉高压组8例。分别测定术前、术后3天及3个月血浆ET-1、NO、ANP含量。结果:术前肺动脉高压组血浆ET-1、NO、ANP水平明显高于无肺动脉高压组(P<0.01)。无肺动脉高压组的ANP水平高于对照组。术后3天肺动脉高压组血浆ET-1、NO、ANP水平即出现下降(P<0.05),术后3个月已接近正常水平。结论:ET-1/NO动态平衡的改变,可能参与了肺动脉高压的发生、发展过程;ANP在肺动脉高压的发病机制中起着有益的生理调节作用;经导管置入AmpJatzer封堵器治疗房间隔缺损明显降低血浆ET-1、NO及ANP含量。     

外科微创封堵治疗成人房间隔缺损合并肺动脉高压的临床分析

目的 探讨外科微创封堵对成人房间隔缺损合并肺动脉高压的治疗作用.方法 自2006年4月至2009年4月,采用外科微创封堵技术,经胸骨旁小切口进胸,在超声心动图的引导下,在心房内释放房间隔封堵器封堵伴有肺动脉高压的房间隔缺损,观察手术效果并对这些患者进行3～6个月的随访观察,并对临床资料进行分析.结果 手术成功率高,无手术死亡,术后心功能明显改善,右心室及肺动脉内径明显缩小,肺动脉压力明显下降,三尖瓣反流明显减轻.结论 外科微创封堵治疗伴肺动脉高压的房间隔缺损是一种安全有效、经济实惠的手术方法.     

Pulmonary function changes in children after transcatheter closure of atrial septal defect

This study was performed to assess changes in pulmonary function test (PFT) and pulmonary outcome after transcatheter closure of atrial septal defect (ASD) in pediatric patients. A total 55 pediatric patients undergoing transcatheter ASD closure received PFT at baseline (day before ASD closure), and at 3 days and 6 months after procedure. Forced vital capacity (FVC), forced expired volume in 1 sec (FEV₁), FEV₁ to FVC ratio (FEV₁/FVC), peak expiratory flow (PEF), and mean forced expiratory flow during the middle half of FVC (FEF_25–75) were measured. Individually, subjects were classified by spirometry as normal, obstructive or restrictive, to evaluate the effect of transcatheter closure on pulmonary outcome. These 55 children had significantly reduced mean PEF and FEF_25–75 (84 ± 24%, P = 0.040 and 76 ± 22%, P = 0.010, respectively) at baseline, with FEF_25–75 reduced significantly at 3 days and 6 months (78 ± 24%, P = 0.010 and 81 ± 24%, P = 0.040, respectively) after transcatheter closure. Six months after transcatheter closure of ASD, significant improvement was observed in mean FVC (94 ± 19% vs. 98 ± 15%, P = 0.034) and FEV₁ (90 ± 20% vs. 96 ± 19%, P = 0.008). Assessed individually, better pulmonary outcome was found in patients without pulmonary hypertension (PH) (χ² = 8.333, P = 0.044). PFT disturbance was observed in significant flow limitation in the peripheral airway of ASD patients. Improved PFT was found after transcatheter closure and better pulmonary outcome was observed in patients without PH. ASD children need monitoring pulmonary function and should receive transcatheter closure before PH develops. Pediatr Pulmonol. 2009; 44:1025–1032. ©2009 Wiley‐Liss, Inc.     

A study of the sequential treatment of acute heart failure with sacubitril/valsartan by recombinant human brain natriuretic peptide: A randomized controlled trial

This study aimed to investigate the effects of the basic treatment for heart failure and sequential treatment with rh-brain natriuretic peptide (rhBNP) alone or the combination of rhBNP and sacubitril/valsartan. Cardiac structure, pulmonary artery pressure, inflammation and oxidative stress in patients with acute heart failure were evaluated.Three hundred patients with acute heart failure were included. According to the random number table method, the patients were divided into 3 groups of 100 patients per group: the standard treatment group (treated with an angiotensin-converting enzyme inhibitor, β receptor blocker, and corticosteroid antagonist), rhBNP group (basic treatment combined with rhBNP) and sequential treatment group (basic treatment for heart failure combined with rhBNP followed by sacubitril/valsartan). The changes in NT-probrain natriuretic peptide (BNP) levels, cardiac troponin T (cTnT) levels, cardiac structure, pulmonary artery pressure, and the levels inflammatory factors and oxidative stress factors were compared among the 3 groups at 1, 4, 12, and 36 weeks after treatment.The sequential treatment group displayed superior outcomes than the standard treatment group and the rhBNP group in terms of left atrium diameter, left ventricular end diastolic volume, left ventricular ejection fraction, pulmonary artery pressure, NT-proBNP levels, and cTnT levels, which respond to damage to the heart structure and myocardium. This result may be related to the decreased levels of inflammatory factors and the correction of oxidative stress imbalance.Sacubitril/valsartan significantly reduce the serum levels of inflammatory factors in patients with acute heart failure while decreasing the levels of oxidizing factors and increasing the levels of antioxidant factors. These changes may be one of the explanations for the better cardiac structure and better pulmonary artery pressure observed in the sequential treatment group.     

房间隔缺损经导管封堵术对心率变异性的影响及意义

目的探讨房间隔缺损(ASD)经导管封堵术对心率变异性(HRV)的影响及意义。方法选择成功接受介入治疗的ASD患者118例为研究对象(ASD组),分别于术前1天及术后第4天记录24h动态心电图,由电脑自动分析并经心电专业人员校正,得出HRV的各项时域指标;另按术前心脏超声测得的肺循环血流量/体循环血流量(Qp/Qs)分为Ⅰ组(Qp/Qs<1.5)与Ⅱ组(Qp/Qs≥1.5),分析两亚组患者HRV,并行Qp/Qs与HRV的相关性分析。结果与对照组比较,ASD组封堵术前后24hRR间期标准差(SDNN)及24h内每5min节段RR间期均值标准差(SDANN)均显著降低(P<0.01或0.05);Ⅱ组降低更明显。ASD组封堵术后RR间期、SDNN及SDANN均较术前增加(P<0.05);Ⅱ组介入治疗术后的SDNN、ASDNN较Ⅰ组术后明显减小(P<0.05)。ASD患者术前SDNN及SDANN与Qp/Qs呈负相关(r值分别为-0.528、-0.644,P<0.01)。结论ASD封堵术后HRV水平明显恢复;Qp/Qs越大的ASD患者不仅术前HRV水平降低更显著,术后的恢复也越慢。     

Immediate and short‐term effects of transcatheter device closure of large atrial septal defect in senior people

Objectives: We sought to evaluate the safety and efficacy in improving cardiac function and functional capacity with device closure of large atrial septal defects (ASD) in senior adults.
Background: Atrial septal defect accounts for about 10% of all congenital heart dis‐ ease. It still remains unclear whether large ASD closure in senior people should be performed or not. Hence we aim to prospectively assess the safety and clinical status of senior patients after transcatheter closure in large ASD.
Patients and interventions: This was a prospective study of all patients aged over 50 years who underwent device closure of a secundum large ASD between January 2013 and January 2018. Investigations including brain natriuretic peptide level, electrocardiography, chest X‐ray, transthoracic echocardiogram, transesophageal echocardiogram, and 6‐minute walk test were performed before and at 2 days and 4 weeks and 6 months after the procedure.
Results: Twenty patients (median age 68 years, 10 women) had transcatheter device closure of large ASD successfully. Median ASD size was 32 mm (range 30‐39 mm). Median pulmonary artery pressure was 58 mm Hg (range 47‐67 mm Hg). At 6 months, there was a significant change in right atrium size (P < .001) and right ventricle size (P < .01) and left ventricle size (P < .001) and also pulmonary artery pressure (P < .0001), New York Heart Association functional class improved (P = .03) in 19 patients and also significant improvement in 6‐minute walk test distance (P < .001). There were no major complications.
Conclusions: Our data showed that large ASD closure at senior people results in sat‐ isfactory cardiac remodeling and cardiac function improvement.     

The use of sildenafil to treat pulmonary hypertension associated with interstitial lung disease

Background and objective: Limited data suggest a benefit following sildenafil treatment in patients with pulmonary hypertension (PH) and interstitial lung disease (ILD). The role of sildenafil in the management of PH in ILD is not clear. We report our experience of ILD patients with PH after 6‐month sildenafil therapy. Methods: We reviewed 15 patients (mean age 55 ± 15 years; 8 men) with ILD (mean FVC 52.6 ± 15.4%) and PH (mean right ventricular systolic pressure 73.8 ± 17.8 mm Hg). Median brain natriuretic peptide: 37 (5–452) pmol/L; mean 6MWD: 156 ± 101 m. Results: Following 6‐month treatment with sildenafil, brain natriuretic peptide levels were lower (n = 12, P = 0.03), 6MWD was higher (n = 6, P < 0.05), but no change in right ventricular systolic pressure (n = 11) was demonstrated. Conclusions: Our observations suggest that sildenafil may be useful in the management of PH in ILD. Controlled trials are warranted before therapeutic recommendations can be made.     

Comparative Changes of Pulmonary Artery Pressure Values and Tricuspid Valve Regurgitation Following Transcatheter Atrial Septal Defect Closure in Adults and the Elderly

Objectives. Opinions vary widely regarding the effectiveness of transcatheter atrial septal defect (ASD) closure in adults, especially in elderly patients. The purpose of this study was to evaluate and compare the hemodynamic changes after transcatheter ASD closure in two groups of patients, one aged 40–59 years (group 1) and one 60 years of age and older (group 2). Methods. Retrospective analysis of patient files. Results. Forty‐six patients were evaluated (23 in each group). Older patients had a higher prevalence of cardiovascular risk factors and established coronary artery disease. There was no statistically significant difference between the two groups in Qp/Qs values, ASD diameter and occluder size. The elderly patients had significantly higher baseline systolic pulmonary artery pressure (PAp) levels ?53 ± 16.2 vs. 39 ± 7.7 mm Hg, P = 0.003. One year following the procedure, the mean reduction in PAp values was 11.3% in group 1 and 19% in group 2 (P = 0.099). While significant baseline tricuspid regurgitation (TR) was more frequent in the elderly patients, no significant TR was observed in either group 1 year following the procedure. Conclusion. Transcatheter ASD closure resulted in significant hemodynamic improvement in all patients, but was even more beneficial in the elderly patient cohort.     

成人房间隔缺损患者血浆氨基末端脑钠肽前体浓度与肺动脉高压的关系

目的通过检测成人房间隔缺损患者血浆氨基末端脑钠肽前体（NT-proBNP）浓度,研究NT-proBNP与肺动脉高压的（PAH）关系,为临床评价先天性心脏病（CHD）相关性肺动脉高压（PAH）的程度提供参考。方法房间隔缺损患者80例为试验组,依据平均肺动脉压（mPAP）分为正常PAH组、轻度PAH组、中度PAH组及重度PAH组各20例;另选20例健康正常人作为对照组。所有患者均行右心导管检查,测右心房、右心室压力、肺动脉收缩压（sPAP）、mPAP与全肺阻力（PVR）。测定患者术前血浆NT-proBNP浓度,分析其与肺动脉压力的相关性。结果房间隔缺损各PAH组血浆NT-proBNP水平明显高于正常对照组,重度PAH组〉中度PAH组〉轻度PAH组〉正常PAH组〉对照组（P〈0.01）。mPAP与NT-proBNP水平呈正相关（r=0.889,P=0.000）,sPAP与NT-proBNP水平呈正相关（r=0.923,P=0.000）,PVR与NT-proBNP水平呈正相关（r=0.835,P=0.000）。血浆NT-proBNP浓度67.53 pg/ml对轻度PAH组有较高的诊断价值;血浆NT-proBNP浓度146.80 pg/ml对中度PAH组、血浆NT-proBNP浓度235.90 pg/ml对重度PAH组有一定的诊断价值。结论房间隔缺损患者血浆NT-proBNP水平随肺动脉压力升高而逐渐增加,可作为评价PAH程度的一项指标。     

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...