Scicchitano Pietro, Gesualdo Michele, Cortese Francesca, Acquaviva Tommaso, de Cillis Emanuela, Bortone Alessandro Santo, Ciccone Marco Matteo
Cardiology Department, Hospital "F. Perinei", SS 96 Altamura-Gravina in Puglia Km. 73,800, 70022, Altamura, BA, Italy.
Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, School of Medicine, Policlinico, University of Bari, Bari, Italy.
Heart Vessels. 2019 Sep;34(9):1499-1508. doi: 10.1007/s00380-019-01385-2. Epub 2019 Mar 20.
Percutaneous closure of atrial septal defect (ASD)/patent foramen ovale (PFO) can influence systemic hemodynamics. The aim of this research was to evaluate the influence of the closure procedure on morphological and functional characteristics of systemic vascular walls. Fourteen ASD (mean age 40 ± 16 years) and 14 PFO (45 ± 8 years) patients were enrolled in this retrospective study. All underwent percutaneous closure procedure; physical, clinical and biochemical evaluations; echocardiography; carotid evaluation; and brachial artery flow-mediated vasodilatation (FMD). All the evaluations were performed at the time of enrollment, 24 h post-procedure, at 1-6-12-month follow-up. FMD at enrollment was higher in PFO patients as compared to ASD (8.5% [7.6-10.7%] versus 6.5% [5.6-7.6%], p < 0.0001). FMD values in ASD patients significantly increased during follow-up (enrollment: 6.5% [5.6-7.6%], 12-month follow-up: 8.8% [7.2-10.3%], p < 0.01). PFO patients showed reduced FMD values 24 h after the procedure (enrollment: 8.5% [7.6-10.7%], 24 h post-procedure: 7% [6.3-9%], p < 0.001), while recovering endothelial function during follow-up period to baseline values (FMD at 12-month follow-up: 8.2% [7.6-10.5%]). At one-year follow-up, FMD remained inversely related to systolic pulmonary arterial pressure and right and left atrial/ventricle chambers dimensions (RV proximal diameter efflux tract, right atrium [RA] longitudinal diameter, RA transverse diameter, RA area, left ventricle [LV] end-diastolic diameter, left atrium [LA] anteroposterior diameter, LA area; p < 0.01) in ASD patients. Endothelial function improved after percutaneous closure of ASD, while remaining stable after PFO closure. Therefore, ASD patients seem to improve their cardiovascular risk profile after percutaneous closure of their defect.
经皮闭合房间隔缺损（ASD）/卵圆孔未闭（PFO）可影响体循环血流动力学。本研究的目的是评估闭合手术对体循环血管壁形态和功能特征的影响。14例ASD患者（平均年龄40±16岁）和14例PFO患者（45±8岁）纳入本回顾性研究。所有患者均接受经皮闭合手术、体格、临床和生化评估、超声心动图检查、颈动脉评估以及肱动脉血流介导的血管舒张功能（FMD）检测。所有评估均在入组时、术后24小时、1个月、6个月和12个月随访时进行。与ASD患者相比，PFO患者入组时的FMD更高（8.5%[7.6 - 10.7%]对6.5%[5.6 - 7.6%]，p<0.0001）。ASD患者随访期间FMD值显著增加（入组时：6.5%[5.6 - 7.6%]，12个月随访时：8.8%[7.2 - 10.3%]，p<0.01）。PFO患者术后24小时FMD值降低（入组时：8.5%[7.6 - 10.7%]，术后24小时：7%[6.3 - 9%]，p<0.001），而随访期间内皮功能恢复至基线值（12个月随访时FMD：8.2%[7.6 - 10.5%]）。在1年随访时，ASD患者的FMD仍与收缩期肺动脉压以及右心房/心室和左心房/心室腔尺寸呈负相关（右心室近端流出道直径、右心房[RA]纵径、RA横径、RA面积、左心室[LV]舒张末期直径、左心房[LA]前后径、LA面积；p<0.01）。经皮闭合ASD后内皮功能改善，而闭合PFO后保持稳定。因此，ASD患者经皮闭合缺损后心血管风险状况似乎有所改善。
