[不同封堵器选择对继发孔型房间隔缺损患者经导管封堵术后心脏重塑的影响]
[The effects of different occluder selection on cardiac remodeling post transcatheter closure in patients with secundum atrial septal defect].
作者信息
Yang Tian-He, Yang Yong-Yao, Jiang Qing-An, Liu Xiao-Qiao, Liang Qin, Tan Hong-Wen, Sang Cai-Hua, Zhang Chang-Hai, Kuang Li-Hong
机构信息
Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang 550002, China.
出版信息
Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Sep;37(9):781-4.
OBJECTIVE
To evaluate the effects on cardiac remodeling post transcatheter closure by Amplatzer septal occluder selected by oval circumference formula in patients with atrial septal defect (ASD).
METHODS
A total of 146 patients with ASD (68 males,mean 33.5 years) treated by transcatheter closure with the Amplatzer occluder were enrolled in this study. The diameter of defects was corrected with the oval circumference formula (group A, 73 cases) or by echocardiography (group B, 73 cases). Cardiac remodeling was assessed by transthoracic echocardiography (TTE) before the procedure, 3 days, 3 months and 6 months after ASD closure.
RESULTS
The mean ASD diameter was similar between the two groups [(20.16 +/- 4.98) mm vs. (21.36 +/- 5.69) mm, P > 0.05] and the mean diameter of the selected occluder of group A was significantly smaller than that in group B [(21.95 +/- 6.78) mm vs. (25.85 +/- 6.75) mm, P < 0.05]. Procedural success rate was identical between the two groups (97.3%) and the defects were completely occluded and there was no residual shunt during the 6 months follow up period, there were also no complications during and after the procedure. The lateral diameter of right atrial (RALD), the diastolic diameter of right ventricle (RVDD), RALD/LALD, RVDD/LVDD and pulmonary diameter (PD) were significantly decreased while the lateral diameter of left atrial (LALD) and left ventricle (LVDD) were significantly increased post ASD closure in both groups. At 6 months follow up, RALD decreased by (18.63 +/- 10.59)% in group A versus (10.14 +/- 6.59)% in group B, LALD increased by (13.42 +/- 8.38)% in group A versus (9.28 +/- 4.95)% in group B and RALD/LALD ratio decreased by (26.35 +/- 11.24)% in group A versus (13.98 +/- 8.96)% in groups B (all P < 0.05).
CONCLUSION
ASD occluder selection based on the oval circumferen ce formula is superior to that made by echocardiography in terms of more favorable cardiac remodeling post ASD closure.
目的
评估采用椭圆周长公式选择Amplatzer房间隔封堵器经导管封堵房间隔缺损（ASD）患者后对心脏重构的影响。
方法
本研究纳入146例采用Amplatzer封堵器经导管封堵治疗的ASD患者（男性68例，平均年龄33.5岁）。缺损直径采用椭圆周长公式校正（A组，73例）或经超声心动图校正（B组，73例）。在ASD封堵术前、术后3天、3个月和6个月采用经胸超声心动图（TTE）评估心脏重构情况。
结果
两组ASD平均直径相似[（20.16±4.98）mm对（21.36±5.69）mm，P>0.05]，A组所选封堵器的平均直径显著小于B组[（21.95±6.78）mm对（25.85±6.75）mm，P<0.05]。两组手术成功率相同（97.3%），缺损完全封堵，在6个月随访期内无残余分流，手术期间及术后也无并发症。两组在ASD封堵术后右心房外径（RALD）、右心室舒张末径（RVDD）、RALD/LALD、RVDD/LVDD及肺动脉直径（PD）均显著降低，而左心房外径（LALD）和左心室舒张末径（LVDD）均显著增加。在6个月随访时，A组RALD降低（18.63±10.59）%，B组降低（10.14±6.59）%；A组LALD增加（13.42±8.38）%，B组增加（9.28±4.95）%；A组RALD/LALD比值降低（26.35±11.24）%，B组降低（13.98±8.96）%（均P<0.05）。
结论
基于椭圆周长公式选择ASD封堵器在ASD封堵术后心脏重构更有利方面优于经超声心动图选择。
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