经导管封堵治疗成人房间隔缺损合并功能性三尖瓣返流

目的 探讨经导管封堵成人房间隔缺损（atrial septal defect, ASD）后能否改善其合并的功能性三尖瓣返流（tricuspid regurgitation, TR）。方法 连续纳入自2019年1月1日～2020年12月31日在空军军医大学西京医院心血管内科经导管封堵的ASD合并功能性TR患者，根据术前超声心动图评估TR严重程度并进行分级，术后6个月进行超声心动图随访，评估功能性TR的改善程度。结果 与合并轻度TR组相比，合并中/重度TR组患者年龄较大（P<0.01）,ASD直径较大，RV直径较大（均P<0.05），与合并中度TR组相比，合并重度TR组患者年龄较大（P<0.01）,RV直径较大（P<0.05）。封堵前，11例患者合并重度TR,18例患者合并中度TR, 71例患者合并轻度TR；封堵术后6个月，10例患者（91%）由重度TR降至轻度，12例患者（67%）由中度TR降至轻度。所有患者中无轻度TR患者的返流量增加至中度或重度。单变量分析显示，持续性TR与肺动脉直径、右房直径、右室直径、左房直径、左室直径及ASD大小相关。经过多变量分析，以上...

Transcatheter closure of atrial septal defect with functional tricuspid regurgitation in adults

AIM To investigate whether transcatheter closure of atrial septal defect (ASD) can improve functional tricuspid regurgitation (TR). METHODS We prospectively enrolled ASD patients with functional TR who underwent transcatheter closure in Xijing Hospital, Air Force Medical University from January 1, 2019 to December 31, 2020. All patients took echocardiography before the transcatheter closure. Functional TR was classified to severe, moderate and mild according to the echocardiographic assessment. Echocardiography follow-up was performed at 6 months after the procedure to evaluate the improvement of TR. RESULTS Compared with the mild TR group, the patients in the moderate/severe TR group were older (P<0.01), the ASD diameter was larger, and the RV diameter was larger (all P<0.05). Compared with the moderate TR group, the patients in the severe TR group were older (P<0.01), and the RV diameter was larger (P<0.05). Before occlusion, 11 patients had severe TR, 18 patients had moderate TR, and 71 patients had mild TR; Six months after occlusion, 10 patients (91%) decreased from severe TR to mild TR, and 12 patients (67%) decreased from moderate TR to mild TR. None of the patients with mild TR had increased reflux to moderate or severe. Univariate analysis showed that persistent TR was associated with, pulmonary artery diameter, right atrial diameter, right ventricular diameter, left atrial diameter, left ventricular diameter and ASD size. Through multivariate analysis, the above factors are not independent predictors. According to the classification of occluder types, it was found that there was no statistical difference between domestic occluder and imported occluder in improving the efficacy of functional TR. CONCLUSION In this single center study, transcatheter closure of ASD improves the functional TR of ASD patients.