国产封堵器介入治疗房间隔缺损后心功能变化的研究

目的探讨国产封堵器介入治疗房间隔缺损(ASD)后心脏形态和功能的变化规律。方法全组60例,年龄5～35(16.10±10.71)岁,体重17～7(243.91±13.21)kg,经胸超声心动图(TTE)示ASD最大径7～3(618.3±7.2)mm,选用封堵器型号为10～4(026±3)mm。术后3d、3个月、6个月和12个月行TTE追踪测量。采用心尖四腔切面面积-长度法计算左右心室容积及射血分数。结果术后3d,右心房上下径、左右径,右心室舒张末期前后径、左右径均逐渐减小(与术前比较,P<0.05);右室舒张末期容积(RVEDV),右室收缩末期容积(RVESV),及右室射血分数(RVEF)均逐渐减小(与术前比较,P<0.05)。3～6个月随访,右心功能进一步改善。至12个月随访时,右心房、右心室大小及右心功能恢复正常(与术前比较,P<0.01)。术后3d,左室舒张末期前后径(LVEDD),左室舒张末期容积(LVEDV)均逐渐增大(与术前比较,P<0.05);左室收缩末期容积(LVESV),左室每搏量(LVSV)及左室射血分数(LVEF)均逐渐增大(与术前比较,P<0.05)。3～6个月随访,左心功能进一步改善。至12个月随访时,左心房、左心室大小及左心室功能恢复正常(与术前比较,P<0.01)。结论国产封堵器介入封堵ASD,既阻断了异常分流,又改善了左心室及右心系统功能及其几何构型。

Cardiac function improvement after transcatheter closure of atrial septal defect using domestic-made occluder

Objective To evaluate the changes of the cardiac morphology and ventricular function after transcatheter closure of atrial septal defect (ASD) using domestic-made occluder device. Methods 60 patients with secundum-type ASD (27 male, 33 female) had ASD closed with domestic-made occluder device. Echocardiographiy were made at 3 days, 3 months, 6 months and 12 months after the procedure. The ventricular volume was calculated with plane area length method. Results The occipitofrontal and left-right diameter of right atrium and right ventricle decreased significantly 3 days after the procedure (P<0.05,P<0.01=. Right ventricular end-diastolic volume (RVEDV) reduced significantly (P<0.05= and right ventricular ejection fraction (RVEF) had a tendency to normalization. RVEDV and RVEF improved further 3-6 months later. After transcatheter closure, left ventricular end-diastolic and end-systolic volume, left ventricular stroke volume, left ventricular ejection fraction and shortening fraction increased significantly. 12 months after the procedure, cardiac size normalized roughly. Conclusions Transcatheter closure of atrial septal defect with domestic-made occluder device can eliminate the abnormal shunt scussfully, decrease the volume load of the right heart and improve left ventricular systolic function and geometry significantly.