Maatouk F, Ben Farhat M, Betbout F, Gamra H, Ben Hamda K, Jarrar M, Hammami S, Added F, Ben Gadha N, Dridi Z
Service de cardiologie, CHU Fattouma-Bourguiba, avenue Farhat-Hached, 5000 Monastir, Tunisie.
Arch Mal Coeur Vaiss. 2001 Mar;94(3):204-10.
The persistence of right ventricular dilatation and paradoxical interventricular septal motion are two echocardiographic abnormalities rarely reported after surgical closure of atrial septal defects. The aim of this study was to identify the predictive factors of these abnormalities in the long-term and to study their functional consequences. One hundred and two patients aged 18 +/- 14 years (range 1-62 years) underwent closure of atrial septal defects. Thirty-five patients were under 10 years of age, 33 were 10 to 20 years of age and 34 were over 20. Fifty-six patients were female. The rhythm was sinus in the great majority of cases (97%). Three patients, all over 40 years of age, were in atrial fibrillation. Before surgery, right ventricular dilatation was observed in 95 patients (91.2%), paradoxical septal wall motion in 93 patients (91.2%), the ratio of pulmonary/systemic output was 2.7 +/- 0.6 (range 1.7 to 7.4) and over 2 in 90% of patients: pulmonary systolic pressure was 32.3 +/- 12 mmHg and over 40 mmHg in 18 patients (17.6%). Ninety-four patients were followed up regularly with a mean follow-up time of 5.5 +/- 3.6 years (1-14 years). The right ventricle remained dilated in 37 patients (39.4%) after surgery: the right ventricular dimension decreased from 36 +/- 1 to 27.8 +/- 6.2 mm (p = 0.001). The ratio of end diastolic right ventricular/left ventricular dimension also decreased from 1.07 +/- 0.31 to 0.56 +/- 0.12 (p = 0.0001). Multivariate analysis identified two predictive factors of persistent right ventricular dilatation: age > 40 years (p = 0.009) and a pulmonary/systemic flow ratio > 3 (p = 0.03). Interventricular septal wall motion remained paradoxical in 21 patients (22%). Multivariate analysis identified two predictive factors of persistent paradoxical septal motion: age > 40 years (p = 0.02) and systolic pulmonary pressures > 40 mmHg (p = 0.03). These abnormalities remained asymptomatic in all but two patients with persistent long-term hypertension and a residual atrial septal defect. The persistence of right ventricular dilatation and paradoxical septal motion was quite common, with older age at surgery, systolic pulmonary artery pressure > 40 mmHg and a ratio of pulmonary/systemic blood flow > 3, being predisposing factors. These abnormalities were clinically asymptomatic when isolated.
右心室扩张和室间隔矛盾运动持续存在是房间隔缺损手术闭合后很少报道的两种超声心动图异常。本研究的目的是确定这些异常的长期预测因素，并研究其功能后果。102例年龄为18±14岁（范围1 - 62岁）的患者接受了房间隔缺损闭合术。35例患者年龄在10岁以下，33例为10至20岁，34例超过20岁。56例患者为女性。绝大多数病例（97%）心律为窦性。3例年龄均超过40岁的患者为心房颤动。手术前，95例患者（91.2%）观察到右心室扩张，93例患者（91.2%）有室间隔矛盾运动，肺循环/体循环输出比为2.7±0.6（范围1.7至7.4），90%的患者该比值超过2；肺收缩压为32.3±12 mmHg，18例患者（17.6%）超过40 mmHg。94例患者接受了定期随访，平均随访时间为5.5±3.6年（1 - 14年）。术后37例患者（39.4%）右心室仍扩张：右心室尺寸从36±1 mm降至27.8±6.2 mm（p = 0.001）。舒张末期右心室/左心室尺寸比也从1.07±0.31降至0.56±0.12（p = 0.0001）。多因素分析确定了持续右心室扩张的两个预测因素：年龄>40岁（p = 0.009）和肺循环/体循环血流比>3（p = 0.03）。21例患者（22%）室间隔运动仍为矛盾运动。多因素分析确定了持续矛盾性室间隔运动的两个预测因素：年龄>40岁（p = 0.02）和收缩期肺压>40 mmHg（p = 0.03）。除两名患有持续性长期高血压和残余房间隔缺损的患者外，所有这些异常均无症状。右心室扩张和矛盾性室间隔运动持续存在相当常见，手术时年龄较大、收缩期肺动脉压>40 mmHg以及肺循环/体循环血流比>3是易感因素。这些异常单独存在时临床上无症状。
