Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
J Card Fail. 2011 Nov;17(11):957-63. doi: 10.1016/j.cardfail.2011.07.003.
Despite advances in device closure for atrial septal defect (ASD), post-closure heart failure observed in adult patients remains a clinical problem. Although right heart volume overload is the fundamental pathophysiology in ASD, the post-closure heart failure characterized by acute pulmonary congestion is likely because of age-related left ventricular diastolic dysfunction, which is manifested by acute volume loading with ASD closure. Aging also appears to play important roles in the pathophysiology of heart failure through several mechanisms other than diastolic dysfunction, including ventricular systolic and vascular stiffening and increased incidence of comorbidities that significantly affect cardiovascular function. Recent studies suggested that accurate assessment of preclosure diastolic function, such as test ASD occlusion, may help identify high-risk patients for post-closure heart failure. Anti-heart failure therapy before device closure or the use of fenestrated device appears to be effective in preventing post-closure heart failure in the high-risk patients. However, the long-term outcome of such patients remains to be elucidated. Future studies are warranted to construct an algorithm to identify and treat patients at high risk for heart failure after device closure of ASD.
尽管在房间隔缺损（ASD）的器械闭合方面取得了进展，但在成年患者中观察到的闭合后心力衰竭仍然是一个临床问题。尽管右心容量超负荷是 ASD 的基本病理生理学，但以急性肺充血为特征的闭合后心力衰竭可能是由于与年龄相关的左心室舒张功能障碍所致，这是由于 ASD 闭合时急性容量负荷增加所致。衰老似乎还通过舒张功能障碍以外的几种机制在心力衰竭的病理生理学中发挥重要作用，包括心室收缩和血管僵硬以及增加对心血管功能有重大影响的合并症的发生率。最近的研究表明，准确评估闭合前舒张功能，例如测试 ASD 闭塞，可能有助于识别闭合后心力衰竭的高危患者。在器械闭合前进行抗心力衰竭治疗或使用带孔器械似乎可以有效预防高危患者闭合后心力衰竭。然而，此类患者的长期预后仍有待阐明。未来的研究需要构建一种算法来识别和治疗 ASD 器械闭合后心力衰竭风险较高的患者。
