经胸房间隔缺损堵闭术对房室瓣反流的影响

目的探讨经胸房间隔缺损封堵术对房室瓣反流的影响。方法回顾性分析2002年1月至2011年3月在南方医科大学珠江医院经胸微创房间隔缺损堵闭术患者的临床资料，其中资料完全者43例，40例在食道超声、2例在经胸超声辅助下行房间隔缺损堵闭术。患者术前、术后1个月及6个月经超声心动图检查，观察心脏各指标的变化和房室瓣反流程度。结果41例手术成功，手术成功率95．3％（41／43）；1例术中改为右侧开胸小切口体外循环下房间隔缺损修补术，1例术中并发心搏骤停。1例术后并发肾功能衰竭：12例术后即时有少量残余漏，1个月后超声复查消失。术后超声随访显示：右心室、右心房直径较前缩小，左心室直径较前增大，肺动脉瓣血流速度明显降低，差异有统计学意义（P〈0．05）；室间隔厚度、二尖瓣血流速度、主动脉瓣血流速度无明显改变，差异无统计学意义（P〉0．05）。房间隔缺损堵闭术后1个月、6个月，二尖瓣瓣膜反流程度较术前加重，差异有统计学意义（平均秩次：2．01VS．2．17vs1．77，x2=10．78，P=0．04）；而三尖瓣的瓣膜反流程度术前与术后1个月、6个月比较，差异无统计学意义（平均秩次：1．88vs2．11US．2．01，X2=4．23，P=0．134）。结论房间隔缺损封堵术后，可引起二尖瓣反流程度的加重，但对三尖瓣的反流程度近期影响不明显；二尖瓣中度以上或三尖瓣重度反流的患者或不适宜行单纯房间缺损封堵术。

Effect of transthoracic atrial septal defect closure on atrioventricular valve regurgitation

Objectives To explore how transthoracic atrial septal defect closure affect atrioventricular valve regurgitation. Methods Retrospective reviews of 43 patients who underwent closure of atrial septal defects in Zhujiang Hospital from January 2002 to March 2011 were included in this study. Among them,40 patients were guided by transesophageal echocardiography, while 2 patients were observed by transthoracic echocardiography. All the patients＇ cardio parameters, complications and extent of atrioventricular valve regurgitation were followed up with echocardiography before and after operation. Results Of the 43 patients, 41 （95.3%） cases were successful, 1 patient was given right transthoracic minimally invasive closure of atrial septal defects under eardiopulmonary bypass, and 1 patient died of cardiac arrest during operation. Acute renal failure appeared in 1 patient 2 days afer operation. Twelve patients were observed leakage from left atrial to right atrial immediately after operation,but the syndrome disappeared one month later. Transthoracic echocardiography demonstrated that right atrial diameter and right ventricular diameter decreased, while left ventricular diameter enlarged, pulmonary blood velocity reduced sharply. The differences were significant （P 〈0.05）. Interventricurlar thickness, mitral flow velocity and aortic blood flow velocity remained stable （P〉0.05）. Mitral valve regurgitation became worse at the time of 1 month and 6 months after operation. The difference was significant when compared with that before operation （rank： 2.01 vs. 2.17 vs. 1.77, X2=10.78,P=0.04）. Meanwhile, tricuspid valve regurgitation hardly changed （rank： 1.88 vs. 2.11 vs. 2.01, X2=4.23,P=0.134）. Conclusions Transthoracic closure of atrial septal defects may worsen mitral valve regurgitation, while it has no obvious influence on tricuspid valve regurgitation for a short time. Patients who had moderate or above mitral valve regurgitation or severe tricuspid valve regurgitation may not be suitable for isolated atrial septal defect closure.