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

Morphological and Functional Changes of the Right Heart After Atrial Septal Defect Device Closure

Objective: To evaluate the changes of the right atrial morphology and right ventricular function after transcatheter closure of atrial septal defect (ASD) and during a subsequent short-term follow-up. Methods: Thirty-six patients with secundum-type ASD (M=11, F=25, range 5-56 years) underwent transcatheter closure by using Amplatzer septal occluder. Echocardiographic examinations were made before, 2 days and 3 months after the closure. The right ventricular volume was calculated with plane area length method. Results: Two days after transcatheter closure the right atrium diameter, occipitofrontal diameter and left-right diameter of right ventricles decreased significantly (p<0.05). Right ventricular end-diastolic volume (RVEDV), right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) reduced significantly (p<0.05). However, right ventricular long axial diameter and right ventricular end-systolic volume (RVESV) were stable (p>0.05). At 3 months the right ventricular long axial diameter shortened significantly (p<0.05 or p<0.01). The right atrium diameter, occipitofrontal diameter and left-right diameter of right ventricles improved constantly. RVEDV, RVESV and RVSV decreased further. RVEF didn't change significantly (p>0.05). Conclusion: Forty-eight hours after ASD closure and during a short-term follow-up, the right heart morphology was increasingly improved, which presented with shortening of right atrium diameter, occipitofrontal diameter and left-right diameter of the right ventricles; Although RVEF was significantly reduced, right heart function didn't change in the following-up period and maintained normal right heart function.