Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China.
Chin Med J (Engl). 2011 Feb;124(4):618-21.
We report a case of acute left ventricular failure at one hour after transcatheter closure of a secundum atrial septal defect (ASD) in a 28-year-old man with hypertrophic cardiomyopathy. Afforded noninvasive mechanical ventilation and the administration of intravenous morphine and high doses of furosemide, the patient exhibited improvement of his clinical condition, reduction of pulmonary congestion at chest X-ray, and satisfactory blood gas analyses in twelve hours. Twenty-four hours later, the patient received oral administration of furosemide and metoprolol. After 7 days the patient was discharged in good clinical condition. At follow-up at 12 months, the patient had remained symptomatically improved from NYHA Class III symptoms before the procedure to Class II symptoms. There was no latent arrhythmia at the follow-up examination. Follow-up transthoracic echocardiography estimated an improvement of the left ventricular function. So, transcatheter closure of a secundum ASD in a patient with hypertrophic cardiomyopathy is feasible, and a thorough understanding of the hemodynamic condition of ASD and hypertrophic cardiomyopathy will reduce the complication of ASD closure.
我们报告了一例 28 岁肥厚型心肌病男性患者在经导管关闭继发房间隔缺损（ASD）后 1 小时发生急性左心衰竭。给予无创机械通气和静脉注射吗啡及大剂量呋塞米后，患者的临床状况得到改善，胸片上的肺充血减少，血气分析在 12 小时内得到满意结果。24 小时后，患者开始口服呋塞米和酒石酸美托洛尔。7 天后，患者临床状况良好出院。12 个月随访时，患者的临床症状从术前 NYHA III 级改善至 II 级。随访时无潜在心律失常。经胸超声心动图随访估计左心室功能有所改善。因此，肥厚型心肌病患者经导管关闭继发 ASD 是可行的，充分了解 ASD 和肥厚型心肌病的血流动力学状况将降低 ASD 关闭的并发症风险。
