介入治疗合并肺动脉高压的中老年继发孔型房间隔缺损的安全性和有效性

目的探讨经导管治疗合并肺动脉高压的中老年继发孔型房间隔缺损(ASD)的安全性和有效性。方法1997年10月至2006年2月,48例合并肺动脉高压(右心导管测量肺动脉平均压>25mmHg)的ASD患者接受了封堵治疗(同期196例无肺动脉高压为对照组)。分析经导管封堵后肺动脉收缩压、心功能以及右心室、肺动脉直径变化。结果48例中47例封堵治疗成功,技术成功率97.9%,即刻残余分流率为2.1%(1/48)。全组缺损经胸超声心动图(TTE)最大径18.9±5.1mm。封堵后即刻肺动脉收缩压由61.2±12.6mmHg降至43.0±8.4mmHg(P<0.01),肺动脉平均压由31.1±4.8mmHg降至26.0±3.4mmHg(P<0.05),全肺阻力由2.9±1.4mmHg.min(Wood单位)降至1.9±0.8mmHg.min(P<0.01)。封堵后第1天,主肺动脉直径由术前的30.2±7.3mm降至27.2±5.8mm(P<0.01),右心室前后径由35.4±7.6mm降至28.0±7.0mm(P<0.01)。全组并发症发生率8.3%(4/48),其中操作相关并发症4.2%。随访8.7±15.4个月(1～60个月),随访期间肺动脉收缩压进一步下降,肺动脉直径、右心室前后径进一步减小,心电图右束支传导阻滞比例降低,NYHA心功能分级改善。结论经导管封堵治疗合并轻中度肺动脉高压的中老年ASD安全、有效,术后肺动脉压降低,心功能改善,近、中期疗效显著。     

房间隔瘤并发继发孔房间隔缺损的介入治疗评价

目的:评价房间隔瘤（ASA）并发继发孔型房间隔缺损（ASD）介入治疗的临床效果。方法:全组21（男8,女13）例,年龄9～56（24士14）岁。经临床、心电图、X线及经胸超声心动图（TTE）检查诊断为ASA并发继发孔型ASD。TTE检查ASA均膨入右心房,测量ASD最大直径12～28（19±7）mm。其中单孔ASD13例,多孔ASD8例,孔间距离1～7mm者7例,12mm者1例。结果:21例均一次封堵成功,技术成功率100%。所用封堵器的直径为16～40（25±8）mm。8例多孔ASD,有7例置入1个封堵器直接封堵多个缺损孔,1例（两个缺损孔之间距离为12mm）分别用18mm和12mm两个封堵器封堵。术后即刻TTE检查显示16例获完全闭合,5例有少或微量残余分流,完全堵闭率76%（16/21）。术后3d复查TTE2例（10%）有微量残余分流。1～6个月复查19例（90%）心脏大小恢复正常,2例（10%）并发心房纤颤患者心脏不同程度的缩小,1例有微量残余分流。1年后随访12例,无封堵器移位及其他并发症。结论:介入治疗房间隔瘤（ASA）并发继发孔型ASD具有操作简便、安全、技术成功率高及封堵效果好等优点。     

50岁以上继发孔型房间隔缺损患者介入治疗和外科手术的对比分析

目的对比介入治疗与外科手术治疗50岁以上继发孔型房间隔缺损(ASD)的安全性和近期疗效。方法回顾性分析50岁以上继发孔型房间隔缺损患者66例,其中介入治疗组30例,外科手术组36例。介入治疗组和外科手术组年龄分别为60.8±7.1岁和57.5±6.3岁(P=0.04),ASD最大直径分别为24.9±7.2mm和30.4±11.0mm(P=0.02),比较两组的疗效、并发症及近期预后。结果介入治疗组和外科手术组即刻成功率分别为93.3%和100%(P=0.85),介入治疗组操作失败2例。手术组住院期间死亡1例(2.6%)。手术组中9例(25.0%)同期行DeVage三尖瓣成形术。术后新发房性心律失常发生率介入治疗组和外科手术组分别为3.3%和22.2%(P=0.03)。介入治疗组和外科手术组术后随访右心房、右心室内径分别由术前38.0±9.0mm、44.2±8.6mm和44.1±8.2mm、49.0±10.2mm缩小至35.2±10.1mm、36.2±9.0mm和38.2±9.5mm、37.1±11.0mm,肺动脉收缩压由术前47.1±17.1mmHg(1mmHg=0.133kPa)和55.3±14.6mmHg下降至39.2±14.1mmHg和46.3±12.9mmHg,两组均较术前差异有统计学意义(P<0.01),下降幅度组间差异无统计学意义(P=0.55,0.49,0.22)。结论介入与手术治疗50岁以上ASD均有较高安全性并能改善右心功能,外科手术因不依赖ASD解剖部位而适应证更广,但术后新发房性心律失常的发生率较介入治疗组高。对于部分选择性病例介入治疗有望取代手术成为首选治疗方法。     

大孔型房间隔缺损封堵治疗的疗效和安全性

目的探讨经导管介入治疗大孔型房间隔缺损(ASD)的疗效和安全性。方法选择经胸超声心动图确诊的大孔房间隔缺损患者46例,年龄8~71岁,平均37.6岁。术前超声心动图检查ASD最大直经25~38(30±8)mm,术前心功能(NYHA分级)Ⅱ级15例,Ⅲ级5例,其中肺动脉平均压力>25mmHg者28例,封堵前肺动脉压力(32±8.2)mmHg。所有患者均在局麻下,应用X光透视,和经胸心脏超声引导下经导管置入国产封堵器,封堵ASD,对部分ASD残端薄弱者采用“肺静脉法”操作技术完成封堵。结果44例封堵成功,技术成功率95.6%。选择封堵器直经为30~42mm,封堵后肺动脉压降低至(18.4±5.8)mmHg。术中未发生任何重要并发症,无急诊手术病例。失败2例患者ASD伸展径分别为36mm和38mm,缺损后缘缺乏有效房隔组织。术后即刻超声显示6例仍存在微量至少量残余分流,分流束直径小于4mm;术后6月超声心动图检查时无1例残余分流,房间隔封堵器位置稳定。术后6~38个月随访,右心房、右心室缩小,心功能明显改善。无封堵器相关并发症。结论国产封堵器介入治疗大孔房间隔缺损具有操作简便、安全、费用低、技术成功率高及封堵效果好等优点。     

房间隔瘤并发继发孔型房间隔缺损介入封堵术的临床评价

目的:评价房间隔瘤(ASA)并发继发孔型房间隔缺损(ASD)介入封堵术的可行性、安全性和疗效.方法:16例(男4例,女12例),年龄12～66(30.6±14.1)岁.经临床、心电图、X线及经胸超声心动图(TTE)检查诊断为ASA并发继发孔型ASD.TTE检查ASA均膨入右心房, ASD最大直径10～32(17.1±10.4)mm.其中单孔ASD 14例,双孔ASD 2例,孔间距离均小于7 mm.结果:16例均一次封堵成功,成功率100%.所用封堵器的直径为16～42(28.5±6.99)mm.2例双孔ASD中,置入1个封堵器直接封堵2个缺损孔.术中TTE监测检查示15例完全闭合, 1例有少量残余分流.术后3 d复查TTE示均无残余分流;6个月、1年后复查示9例心脏大小恢复正常, 均无残余分流,无封堵器移位及其他并发症.结论:介入封堵治疗ASA并发继发孔型ASD是可行、安全的, 可获得良好的封堵效果.     

老年房间隔缺损的介入治疗及疗效分析

目的探讨老年（≥60岁）继发孔型房间隔缺损（ASD）的介入治疗适应征、操作原则及临床效果。方法32例老年人继发孔型房间隔缺损患者，用经胸及经食道超声测量ASD直径、位置及大小，选择合适的封堵器，先行冠状动脉造影及右心导管检查，应用国产或进口房间隔缺损封堵器进行介入治疗。同时或分期治疗其他合并症并观察其疗效。结果31例老年ASD患者封堵成功，出现心包填塞1例，残余分流1例，并发症发生率6．2％。1例同期行冠状动脉支架植入术（PTCA），1例择期行射频消融术。结论老年人的继发孔型房间隔缺损介入治疗有其特殊性和危险性，严格掌握适应征，规范操作，认真制定手术方案，其安全性较高，并发症少。     

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.     

微创心脏不停跳修补单纯房间隔缺损10例报告

1999年11月～2001年4月,我们采用微创技术在心脏跳动下修补单纯房间隔缺损10例,效果满意.现报告如下. 资料与方法:本组男3例,女7例;年龄6～11岁,平均(8.4±2.6)岁;体重28～52kg,平均36.9kg.均为继发孔型房间隔缺损(ASD),其中中央型6例、下腔型4例,缺损直径为0.9～2.0cm.10例患者均经心电图、X线胸片及彩色多普勒超声心动图明确诊断.     

老年房间隔缺损患者经导管封堵治疗的可行性及疗效

目的　探讨经导管封堵治疗老年房间隔缺损患者的可行性及疗效。方法　 19例年龄≥ 6 0岁的老年房间隔缺损患者 ,术前经胸超声测量房间隔缺损直径为 10～ 34(2 4 .4± 8.2 )mm ,其中 3例患者为双孔型房间隔缺损。 11例患者合并心房颤动或阵发性心房颤动。X线胸片示心胸比例均 >0 .5 (0 .5 2～ 0 .70 )。术前心功能 (NYHA分级 )Ⅱ级8例 ,Ⅲ级 9例 ,Ⅳ级 2例。所有患者均在局麻下 ,应用X线透视和经胸心脏超声引导行房间隔缺损封堵术。结果术中测肺动脉平均压力 2 1～ 4 7mmHg(1mmHg=0 .133kPa) ,其中肺动脉平均压力 >2 5mmHg者 16例。所有患者均用Amplatzer房间隔缺损封堵器或国产双盘状封堵器一次封堵治疗成功。所用封堵器直径为 14～ 38mm。 3例双孔型缺损 ,2例用 2 8mm和 32mm封堵器一并封堵 ,另 1例用直径 14mm和直径 2 6mm的封堵器封堵成功。所有患者于术后 5～ 7d行经胸心脏超声检查 ,无残余分流。术后患者心功能明显改善 ,随访 1～ 30个月 ,无封堵器相关的并发症。结论　经导管封堵治疗老年房间隔缺损患者是一种安全有效的方法。     

Amplatzer封堵器治疗房间隔缺损(附9例报告)

目的 应用Amplatzer封堵器治疗继发孔型房间隔缺损（ASD）并评价其疗效。方法 9例患者,男3例,女6例,年龄8～52（33.0±5.2）岁,体重22 kg以上。经临床、心电图、x线胸片和经超声心动图（TEE）检查诊断继发孔型ASD,导管法测定肺动脉收缩压24～46（24.4±5.5）mmHg（1mmHg=0.133 kPa）,经心内球囊测定法测定ASD直径11～30（23.3±6.2）mm。手术在X线透视和TEE监视下进行。用10F、11F或12F导管装载Amplatzer封堵器经皮穿刺插入封堵治疗ASD。术后24h、1、3、6个月行胸壁超声心动图和X线胸片评价效果。结果 手术全部获得成功,8例术后即时做TEE检查示ASD立即关闭,次日病人即能下床活动。1例有残余微量分流,1个月后仍然存在,6个月时分流消失。1例在术中发生脑栓塞,经及时用尿激酶溶栓治疗痊愈。结论 Amplatzer封堵器治疗继发孔型ASD是一种有效的非手术治疗方法,具有安全、操作简便、成功率高的特点。     

The short- and medium-term results of transcatheter closure of atrial septal defect with severe pulmonary arterial hypertension

We investigated the short-term and medium-term results in patients with pulmonary arterial hypertension (PAH) associated with atrial septal defect (ASD) undergoing transcatheter closure. Fifteen patients with severe PAH associated with ASD who underwent successful occluder implantation from 2007 to 2010 were included. Clinical, echocardiographic, and hemodynamic data were reviewed. Severe PAH was defined as pulmonary arterial systolic pressure measured by catheterization was ≥60 mmHg and pulmonary vascular resistance (PVR) ≥6 Wood Units (WU). Compared with baseline, the 6-minwalking distance significantly increased by 29.7 ± 26.3 m (P < 0.001) at 3 months (short-term) and 65.4 ± 63.6 m (P < 0.001) at 23.4 ± 9.7 months (medium-term), World Health Organization function class considerably improved after postclosure short-term and medium-term. Repeat cardiac catheterization (n = 7) showed that mean pulmonary arterial pressure decreased from 51.6 ± 9.4 mmHg at baseline to 21.0 ± 3.8 mmHg (P < 0.001) at follow-up of 12 months. The PVR decreased by 5.6 ± 1.1 WU (P < 0.001). Through carefully selected patients with severe PAH associated with ASD, transcatheter closure can be safely performed with a promising short-term and medium-term outcome. Trial occlusion is an effective way for deciding the reversibility of severe PAH in ASD patients. The role of aerosolized iloprost for pulmonary vasoreactivity testing in patients with severe PAH secondary to ASD requires further investigation.     

Home-made fenestrated amplatzer occluder for atrial septal defect and pulmonary arterial hypertension

We report the management of a patient with secundum atrial septal defect (ASD) and severe pulmonary hypertension. A 65-year-old male with recently diagnosed atrial septal defect was referred to our centre for decompensated right heart failure with rest and exercise induced dispnea and severe pulmonary hypertension. Right heart catheterization confirmed a mean pulmonary pressure of about 55 mmHg and a Qp/Qs of 2.7. An occlusion test with a compliant large balloon demonstrated partial fall of pulmonary arterial pressure. The implantation of a home-made fenestrated Amplatzer ASD Occluder (ASO) was planned in order to decrease left-to-right shunt and promote further decrease of pulmonary arterial pressure in the long-term. Thus, by means of mechanical intracardiac echocardiography study with a 9F 9 MHz UltraIce catheter (Boston Scientific Corp.), we selected a 34 mm ASO for implantation. Four millimeter fenestration was made inflating a 4 mm non-compliant coronary balloon throughout the waist of the ASO, which was successfully implanted under intracardiac echocardiography. After six months, a decrease of pulmonary arterial pressure to 24 mmHg and full compensated right heart failure was observed on transthoracic echocardiography and clinical examination. This case suggests that transcatheter closure with home-made fenestrated ASD in elderly patients with severe pulmonary hypertension is feasible.     

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。     

老年先天性心脏病心房间隔缺损患者左心室舒张功能受限的诊断和介入治疗前的预适应治疗

目的:探讨诊断和预防老年(>60岁)房间隔缺损(ASD)患者内科介入治疗后发生急性左心衰竭(心衰)至肺水肿风险的方法和手段。方法:术前进行常规经胸超声心动图检查(TTE),术中先行球囊封堵ASD,测量左心房压力。如果球囊封堵ASD后,左心房平均压升至10 mm Hg(1 mm Hg=0.133kPa)以上时,定义为左心室舒张受限(LVR)。对于此类患者暂停此次介入,并给予左心室预适应治疗(LVPCT)48 h,然后进行第2次介入治疗。术后将有创血流动力学指标与TTE结果进行对比。结果:23例患者,15例患者在第1次介入治疗过程中,没有发现LVR,ASD介入治疗1次完成。8例患者(34.8%)在第1次介入治疗过程中,被诊断LVR。其中6例患者的左心房平均压在经过48 h的LVPCT后显著下降,第2次介入治疗时封闭ASD。其余2例患者在接受48 h LVPCT后,球囊导管测量ASD封堵后左心房平均压仍>10 mm Hg,其中1例患者在术后发生急性左心衰竭。通过与有创血流动力学指标对比,胸骨旁长轴M型超声测量左心室舒张末期直径(LVEDD)≤40 mm和右心室舒张末期直径(RVEDD)≥30 mm合并心室间隔矛盾运动可预见LVR的存在(P<0.05)。结论:术前超声心动图可以预测左心室舒张受限的存在。介入治疗术中使用球囊封堵ASD后测量左心房压有助于诊断LVR。术前静脉LVPCT可以有效预防术后充血性心衰的出现。     

成年特殊房间隔缺损患者的介入封堵治疗

目的观察成年巨大继发孔型房间隔缺损患者进行介入封堵治疗的疗效和安全性。方法对43例成年继发孔型房间隔缺损患昔在经食管超声指导下进行手术,封堵前后检测肺动脉压、右室压,术前、术后72小时、术后1～3个月行心电图和超声心动图检查。结果成功封堵38例,手术后即刻成功率为88．4％。封堵前、后平均肺动脉压、平均右事压降低（P〈0．05）;术后72小时内出现封堵器脱落1例（2．6％）、术后心包积液1例（2．6％）、心律失常5例（13．2％）、急性心功能不全3例（7．9％）,术后即刻残余分流6例（15．8％）。术后l～3个月随访经胸超声心动图检查显示均完全闭合。术后1个月随访发现右室容积缩小、射血分数升高。患者随访1～3个月,均未发现有残余分流、脱落、栓塞。结论成年巨大继发孔型房问隔缺损患者行介入封堵治疗相对安伞、有效,体表超声心动图或经食管超声心动图的术中监测对提高手术成功率有指导意义。     

同期介入治疗先天性心脏病复合畸形30例的疗效观察

目的探讨经导管同期介入治疗先天性心脏病复合畸形的方法及疗效。方法先心病复合畸形30例,男性14例,女性16例,平均年龄（17．9±13．5）岁,平均体重（38．8±22．0）kg。复合类型为：房间隔缺损（ASD）并动脉导管未闭（PDA）7例,ASD并室间隔缺损（VSD）10例,ASD并肺动脉瓣狭窄（PS）6例,VSD并PDA5例,PDA并PS1例,VSD并PDA并ASD1例。经导管治疗原则：先行瓣膜球囊扩张术纠正瓣膜狭窄,其次行VSD封堵术,再行PDA封堵术,最后行ASD封堵术,可根据具体情况相应调整。术后2d、1个月、3个月、6个月、1年复查超声心动图及心电图。结果30例复合型先天性心脏病患者均一次治疗成功。7例合并PS患者,跨肺动脉瓣压差由术前（46．1±15．1）mmHg下降到术后（17．6±3．8）mmHg（P〈0．01）,1例室间隔缺损术后心电图提示不完全右束支传导阻滞,1例室间隔缺损术后心电图提示完全右束支传导阻滞,1例室间隔缺损术后心电图提示不完全左束支传导阻滞,给予地塞米松治疗后,心电图复查正常。1例VSD并ASD患者术前心电图提示双束支传导阻滞,术后观察10d仍存在,给予置人心脏永久起搏器。2例VSD并PDA患者术后超声心动图提示心室水平微量分流,6个月时随访分流消失。所有患者随访无不良并发症发生。结论对先天性心脏病复合畸形,严格掌握介人治疗适应证,选择正确的操作顺序和方法,可以取得良好的效果。     

Pulmonary arterial compliance in children with atrial and ventricular septal defect

Previous studies have documented the normal values of pulmonary arterial compliance (Cp) in animals and adult humans. In the past, variations in Cp and its measurement in children with septal defects has been unknown. In the present study, we found the Windkessel model, which uses compliance and resistance as parameters, to be a useful tool in understanding Cp in pediatric patients. Calculations of Cp were based on the pulmonary arterial diastolic pressure waveform as an exponential function of time. First, Cp was estimated by studying pressure tracings of the main pulmonary artery (MPA) obtained from both routine cardiac catheterization and pressure measured by a catheter-tip manometer, which was performed during a catheterization study of seven children with various congenital heart diseases. Second, 124 children with atrial and ventricular septal defects aged between 45 days and 12 years were studied using the data obtained from routine catheterization. Hemodynamic data were used to calculate pulmonary vascular resistance (Rp), pulmonary arterial time constant (Tp) and Cp. A strong correlation (r = 0.954) was found in the Cp value estimated by data obtained from routine catheterization and from the catheter-tip manometer study. The present study shows an estimated mean (SEM) Cp in normal children of 1.53 (0.17) ml/mmHg per m². The estimated mean (SEM) Cp was 1.91 (0.10) and 1.70 (0.11) ml/mmHg per m² in children with atrial septal defect (ASD) and ventricular septal defect (VSD), respectively. It was found that Cp was significantly (P = 0.04) higher in female patients with a VSD. Also, a significantly low Cp (0.95 ± 0.06 ml/mmHg per m²) was observed in patients with a VSD and pulmonary hypertension (VSDPH). In conclusion, Cp was calculated by the exponential decay portion of the MPA diastolic pressure waveform. A normal Cp value was observed in ASD and VSD patients and a significantly low Cp was observed in children with a VSDPH. Cp was higher in female VSD patients than in male VSD patients. Received: January 5, 2000 / Accepted: September 12, 2000     

Surgical closure of atrial septal defect in patients older than 30 years: risk factors for late death from arrhythmia or heart failure

BACKGROUND: Little is known about prognostic markers for late cardiac-related death after surgical atrial septal defect (ASD) closure in adults. METHODS: Long-term follow-up data of 281 patients who underwent surgical secundum ASD closure when they were older than 30 years, were retrospectively examined. RESULTS: Mean age at surgery was 43.8 +/- 10.0 years (30 to 76 years). There were 2 early deaths. Mean follow-up was 14.1 +/- 8.4 years (0.4 to 28.9 years). Death from arrhythmia or heart failure occurred in 9 patients (3.6 %) at a mean time of 8.5 +/- 6.6 years after the operation. Patients > 43 years exhibited significantly higher pulmonary artery pressures. Preoperative systolic pulmonary artery pressure > 36 mmHg, and mean pulmonary artery pressure > 21 mmHg were predictive of late death from arrhythmia or heart failure. However, age at operation was not. CONCLUSIONS: Older age at the time of ASD closure is not a risk factor for late death from arrhythmia or heart failure in adults. However, older patients presented more often with pulmonary hypertension. Since elevated pulmonary artery pressure is predictive of late death from arrhythmia or heart failure, timely ASD closure is warranted.     

60岁以上老年继发孔型房间隔缺损的治疗策略(附139例临床分析)

目的:介绍老年继发孔型房间隔缺损(ASD)的几种治疗方法,并分析其治疗效果。方法:自2002年1月至2009年6月,我院收治的139例60岁以上的老年继发孔型ASD病例。其中43例行经导管房缺封堵术;21例行微创经胸房缺封堵术;55例行体外循环下房缺修补术;20例因各种原因未行手术,给予药物保守治疗。结果:导管封堵组、经胸封堵组、和手术修补组患者均无死亡。术后远期随访导管封堵组,1例术后第4年死于脑出血。其余2组术后远期随访无死亡。房缺闭合术后心功能较术前明显改善,术后早期复查超声心动图均无残余分流,右心房、右心室明显缩小,肺动脉压力明显降低。保守治疗组,随访病例共有8例死亡。其中4例死于心力衰竭(心衰),1例死于心衰合并尿毒症,1例死于脑出血,1例死于呼吸衰竭,1例死因不详。结论:高龄本身并非老年房间隔缺损手术禁忌,老年患者通过封堵器或手术闭合房缺仍可以重构右心房、右心室,降低肺动脉压,显著改善心功能。3种闭合方法各有优缺点,应根据具体情况选择手术方式。     

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。