无症状成人经导管房间隔缺损封堵术后心肺功能改善的决定因素。

Determinants of cardiopulmonary functional improvement after transcatheter atrial septal defect closure in asymptomatic adults.

作者信息

Giardini Alessandro, Donti Andrea, Formigari Roberto, Specchia Salvatore, Prandstraller Daniela, Bronzetti Gabriele, Bonvicini Marco, Picchio Fernando M

机构信息

Pediatric Cardiology and Adult Congenital Unit, Bologna, Italy.

出版信息

J Am Coll Cardiol. 2004 May 19;43(10):1886-91. doi: 10.1016/j.jacc.2003.10.067.

DOI:10.1016/j.jacc.2003.10.067

PMID:15145116

Abstract

OBJECTIVES

We sought to evaluate the course of cardiopulmonary function after transcatheter atrial septal defect (ASD) closure and to identify the physiopathologic mechanisms leading to this change.

BACKGROUND

Conflicting reports exist on cardiopulmonary functional improvement in asymptomatic adults after transcatheter closure of a secundum ASD.

METHODS

Thirty-two consecutive adults (13 males; age 42.6 +/- 16.7 years) underwent maximal cardiopulmonary exercise testing and transthoracic echocardiography both on the day before and six months after transcatheter ASD closure. Mean pulmonary artery pressure, pulmonary to systemic flow ratio (Qp/Qs), and ASD diameter were measured before closure.

RESULTS

Peak oxygen uptake (Vo(2)) (p < 0.001), peak oxygen pulse (p = 0.0027), and vital capacity (p = 0.0086) improved after ASD closure, although peak heart rate did not. A significant correlation was found between peak Vo(2) improvements and Qp/Qs (p = 0.0013). Left ventricular ejection fraction (LVEF) (p < 0.0001) and left ventricular end-diastolic diameter (LVEDD) (p < 0.0001) significantly increased after six months, although left ventricular end-systolic diameter did not. Right ventricular long- and short-axis dimensions decreased (both p < 0.0001). Peak Vo(2) and of peak oxygen pulse improvements correlated to both LVEF (p = 0.0009 and 0.0019, respectively) and LVEDD (p < 0.0001 and 0.032, respectively) increments. The decrease of both long- and short-axis right ventricular dimensions positively correlated to both LVEF and LVEDD improvements. The improvement in LVEF correlated to Qp/Qs (p = 0.0026).

CONCLUSIONS

Transcatheter ASD closure leads to a significant improvement in cardiopulmonary function within six months, via an increase in peak oxygen pulse. An increase in both left ventricular stroke volume and cardiac output due to a positive ventricular interaction is the mechanism leading to improved peak Vo(2).

摘要

目的

我们试图评估经导管房间隔缺损（ASD）封堵术后心肺功能的变化过程，并确定导致这种变化的病理生理机制。

背景

关于继发孔型ASD经导管封堵术后无症状成年人心肺功能改善的报道存在矛盾。

方法

32例连续入选的成年人（13例男性；年龄42.6±16.7岁）在经导管ASD封堵术前一天及术后6个月均接受了最大心肺运动试验和经胸超声心动图检查。封堵术前测量平均肺动脉压、肺循环与体循环血流量比值（Qp/Qs）以及ASD直径。

结果

ASD封堵术后，峰值摄氧量（Vo₂）（p<0.001）、峰值氧脉搏（p = 0.0027）和肺活量（p = 0.0086）均有所改善，尽管峰值心率未改善。峰值Vo₂的改善与Qp/Qs之间存在显著相关性（p = 0.0013）。6个月后，左心室射血分数（LVEF）（p<0.0001）和左心室舒张末期内径（LVEDD）（p<0.0001）显著增加，尽管左心室收缩末期内径未增加。右心室长轴和短轴尺寸减小（均p<0.0001）。峰值Vo₂和峰值氧脉搏的改善与LVEF（分别为p = 0.0009和p = 0.0019）及LVEDD增加（分别为p<0.0001和p = 0.032）均相关。右心室长轴和短轴尺寸的减小与LVEF和LVEDD的改善均呈正相关。LVEF的改善与Qp/Qs相关（p = 0.0026）。