Xu Xu-Dong, Ding Xue-Yan, Liu Su-Xuan, Bai Yuan, Zhao Xian-Xian, Qin Yong-Wen
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
Cardiovascular Therapeutic Center of the 117 Hospital of the Chinese People's Liberation Army, Hangzhou 310007, PR China.
J Cardiol. 2015 Jan;65(1):32-6. doi: 10.1016/j.jjcc.2014.03.014. Epub 2014 May 17.
The feasibility and efficacy of simultaneous percutaneous treatment of secundum type atrial septal defect (ASD) combined with pulmonary valve stenosis (PS) have not been proved.
To evaluate the safety and efficacy on the clinical benefit of simultaneous percutaneous correction of these two pathologies under local anesthesia and without transesophageal echocardiography guidance.
Transpulmonary gradient, functional status, pulmonary regurgitation (PR), and tricuspid regurgitation (TR) were studied in 35 patients undergoing percutaneous balloon pulmonary valvuloplasty and ASD closure from March 2004 to July 2012. All patients were followed up until January 2013, an average of 39 months.
According to color Doppler transthoracic echocardiography (TTE) before the intervention, the ASD defect size and transpulmonary gradient were 17±8.4 mm and 88±37.8 mmHg, respectively. Post-interventionally, the peak-to-peak transpulmonary gradient decreased from 77±37.6 mmHg to 20±16.2 mmHg (p<0.001) and the ASD occluder size was 23±10.5 mm. In all those patients, there was no residual shunt detected, and moderate and severe TR decreased from 45.7% (16/35) and 20% (7/35) to 8.6% (3/35) and 5.7% (2/35) before and after intervention detected by TTE, respectively. Eight patients had mild PR after procedure and two of them recovered at 6 months and no patient encountered severe adverse events at the latest follow-up.
Simultaneous percutaneous corrections of ASD combined with PS are feasible, safe, and effective with satisfactory results.
继发孔型房间隔缺损（ASD）合并肺动脉瓣狭窄（PS）同期经皮治疗的可行性和疗效尚未得到证实。
评估在局部麻醉且无经食管超声心动图引导下同期经皮纠正这两种病变对临床益处的安全性和疗效。
对2004年3月至2012年7月期间接受经皮球囊肺动脉瓣成形术和ASD封堵术的35例患者的跨肺压差、功能状态、肺动脉反流（PR）和三尖瓣反流（TR）进行研究。所有患者随访至2013年1月，平均39个月。
根据干预前彩色多普勒经胸超声心动图（TTE），ASD缺损大小和跨肺压差分别为17±8.4 mm和88±37.8 mmHg。干预后，峰-峰跨肺压差从77±37.6 mmHg降至20±16.2 mmHg（p<0.001），ASD封堵器大小为23±10.5 mm。在所有这些患者中，未检测到残余分流，TTE检测到中度和重度TR在干预前后分别从45.7%（16/35）和20%（7/35）降至8.6%（3/35）和5.7%（2/35）。8例患者术后有轻度PR，其中2例在6个月时恢复，在最近一次随访中无患者发生严重不良事件。
ASD合并PS同期经皮纠正是可行、安全且有效的，结果令人满意。
