Kaya Mehmet G, Baykan Ali, Dogan Ali, Inanc Tugrul, Gunebakmaz Ozgur, Dogdu Orhan, Uzum Kazim, Eryol Namik K, Narin Nazmi
Department of Cardiology, Erciyes University School of Medicine, 38039 Kayseri, Turkey.
Pediatr Cardiol. 2010 May;31(4):474-82. doi: 10.1007/s00246-009-9623-y. Epub 2010 Jan 19.
The study aimed to investigate the intermediate-term effects of transcatheter atrial septal defect (ASD) closure on cardiac remodeling in children and adult patients. Between December 2003 and February 2009, 117 patients (48 males, 50 adults) underwent transcatheter ASD closure with the Amplatzer septal occluder (ASO). The mean age of the patients was 15 years, and the mean follow-up period was 25.9 +/- 12.4 months. New York Heart Association (NYHA) class, electrocardiographic parameters, and transthoracic echocardiographic (TTE) examination were evaluated before the ASD closure, then 1 day, 1 month, 6 months, 12 months, and yearly afterward. Transcatheter ASD closure was successfully performed for 112 (96%) of the 117 patients. The mean ASD diameter measured by transesophageal echocardiography (TEE) was 14.0 +/- 4.2 mm, and the mean diameter stretched with a sizing balloon was 16.6 +/- 4.8 mm. The mean size of the implanted device was 18.6 +/- 4.9 mm. The Qp/Qs ratio was 2.2 +/- 0.8. The mean systolic pulmonary artery pressure was 40 +/- 10 mmHg. At the end of the mean follow-up period of 2 years, the indexed right ventricular (RV) end-diastolic diameter had decreased from 36 +/- 5 to 30 +/- 5 mm/m(2) (p = 0.005), and the indexed left ventricular (LV) end-diastolic diameter had increased from 33 +/- 5 to 37 +/- 6 mm/m(2) (p = 0.001), resulting in an RV/LV ratio decreased from 1.1 +/- 0.2 to 0.8 +/- 0.2 (p = 0.001). The New York Heart Association (NYHA) functional capacity of the patients was improved significantly 24 months after ASD closure (1.9 +/- 0.5 to 1.3 +/- 0.5; p = 0.001). At the 2-year follow up electrocardiographic examination, the P maximum had decreased from 128 +/- 15 to 102 +/- 12 ms (p = 0.001), the P dispersion had decreased from 48 +/- 11 to 36 +/- 9 ms (p = 0.001), and the QT dispersion had decreased from 66 +/- 11 to 54 +/- 8 ms (p = 0.001). Five of six patients experienced resolution of their preclosure arrhythmias, whereas the remaining patient continued to have paroxysmal atrial fibrillation. A new arrhythmia (supraventricular tachycardia) developed in one patient and was well controlled medically. Transcatheter ASD closure leads to a significant improvement in clinical status and heart cavity dimensions in adults and children, as shown by intermediate-term follow-up evaluation. Transcatheter ASD closure can reverse electrical and mechanical changes in atrial myocardium, resulting in a subsequent reduction in P maximum and P dispersion times.
该研究旨在调查经导管房间隔缺损（ASD）封堵术对儿童和成年患者心脏重塑的中期影响。在2003年12月至2009年2月期间，117例患者（48例男性，50例成年人）接受了使用Amplatzer房间隔封堵器（ASO）的经导管ASD封堵术。患者的平均年龄为15岁，平均随访期为25.9±12.4个月。在ASD封堵术前、术后1天、1个月、6个月、12个月及之后每年评估纽约心脏协会（NYHA）心功能分级、心电图参数和经胸超声心动图（TTE）检查。117例患者中有112例（96%）成功进行了经导管ASD封堵术。经食管超声心动图（TEE）测量的ASD平均直径为14.0±4.2mm，用测量球囊扩张后的平均直径为16.6±4.8mm。植入装置的平均尺寸为18.6±4.9mm。Qp/Qs比值为2.2±0.8。平均收缩期肺动脉压为40±10mmHg。在平均2年的随访期末，右心室（RV）指数化舒张末期直径从36±5降至30±5mm/m²（p = 0.005），左心室（LV）指数化舒张末期直径从33±5增至37±6mm/m²（p = 0.001），导致RV/LV比值从1.1±0.2降至0.8±0.2（p = 0.001）。ASD封堵术后24个月患者的纽约心脏协会（NYHA）心功能显著改善（1.9±0.5至1.3±0.5；p = 0.001）。在2年随访的心电图检查中，P波最大值从128±15降至102±12ms（p = 0.001），P波离散度从48±11降至36±9ms（p = 0.001），QT离散度从66±11降至54±8ms（p = 0.001）。6例患者中有5例封堵术前的心律失常消失，而其余1例患者仍有阵发性心房颤动。1例患者出现了新的心律失常（室上性心动过速），经药物治疗得到良好控制。中期随访评估显示，经导管ASD封堵术可使成人和儿童的临床状况和心腔尺寸得到显著改善。经导管ASD封堵术可逆转心房心肌的电和机械变化，从而使P波最大值和P波离散度时间随后降低。
