房间隔缺损封堵术后心脏的形态重构和电重构

目的了解经导管房间隔缺损（ASD）封堵术后心脏几何构型和电生理的变化。方法记录24例ASD患者经导管封堵术前及术后1个月、6个月心电图（ECG）及经胸超声心动图（TTE）测量指标的变化，ECG指标包括PR间期、QRS时限和QTc；TTE测量指标包括收缩末期左房横径（LAD）、右房横径（RAD）、计算RAD／LAD比值；右室舒张末期内径（RVDD），左心室舒张末期内径（LVDD），计算RVDD／LVDD比值。结果患者术后1个月与术前相比，RAD由（42±10）mm降至（36±8）mm（P〈O．01），RACl／LAD由1．3±0．2降至1．1±0．1（P〈O．05）；RVDD由（33±8）mm降至（27±6）mm（P〈O．01），LVDD由（40±7）mm升至（45±6）mm（P〈0．01），RVDD／LVDD由0．8±0．1降至0．6±0．1（P-（0．05）。术后6个月时，RAD降至（32±8）mm，PR问期由（135±20）ms降至（127±18）ms（Pd0．01），QRS时限由（101±10）ms降至（92±11）ms（Pd0．01），QTc由（430±20）ms降至（425±18）ms（Pd0．05）。LAD至术后6个月时仍无显著变化。结论ASD的介入封堵治疗减轻了右心系统的容量负荷，使心脏的几何构型在术后早期即发生改变，电生理在随后数月也发生变化。介入封堵术逆转了ASD患者的，心脏重构。

The cardiac and electrophysiology remodeling after transcatheter closure of atrial septal defects

Objective To study the cardiac geometric and electrophysiology changes after transcatheter closure of atrial septal defects（ASDs）. Methods There were 24 patients enrolled in our study with mean age 35.64 years. Cardiac geometric changes were assessed by echoeardiography 1 and 6 months after closure of ASDs, as well as electrocardiogram parameters were also assessed. Results One month After ASD closure, right atrial diameter（RAD） reduced from 42~ 10ram to36：1：8 ram, while left atrial diameter（LAD） did not change. The right ventricular geometric changes resulted in an RVDD/LVDD ratio decreased significantly（P〈0.05）. Six month thereafter, RAD continuously reduced to 32±8 ram, meanwhile PR duration decreased from 135±20 ms to 127±18ms（P〈0. 01）, and QRS duration decreased from 101±10ms to 92±11ms （P〈0.01）, also the QTc decreased from 430 ± 20 ms to 425 i 18 ms（P〈0.05）. Conclusions Percutaneous ASD closure results in early and striking cardiac geometric changes because the release of right heart over- load, and electrophysiology parameters changes few months whereafter. The cardiac remodeling can be reversed by Per- cutaneous closure in ASD patients.