Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Interv Cardiol. 2021 Jan 17;2021:8846656. doi: 10.1155/2021/8846656. eCollection 2021.
The age of candidates for device closure of atrial septal defect (ASD) has been increasing. Thus, concerns exist about dyspnea aggravation or atrial fibrillation development after device closure due to augmentation of left ventricular (LV) and left atrial (LA) preload. This study aimed to examine patterns and determinants of serial pulmonary arterial pressure and left ventricular filling pressure changes after device closure of ASD.
Among the 86 consecutive patients who underwent percutaneous device closure of ASD, those with end-stage renal disease or those without pre- or postprocedural Doppler data were excluded. The clinical, transesophageal, and transthoracic echocardiographic findings of 78 patients were collected at baseline, one-day postprocedure, and one-year follow-up.
The mean age of study patients was 49.8 ± 15.0 years, and the average maximal defect diameter and device size were 20.2 ± 6.0 mm and 23.8 ± 6.4 mm. Four patients (5.6%) underwent new-onset atrial fibrillation, and five patients (6.4%) took diuretics within one-year after closure. Some patients ( = 21; 27%) exhibited paradoxically increased tricuspid regurgitant velocity (TRV) one-day postprocedure; they also were older with lower e', glomerular filtration rate, and LV ejection fraction and a higher LA volume index. However, even in these patients, TRV deceased below baseline levels one-year later. Both E/e' and LA volume index significantly increased immediately after device closure, but all decreased one-year later. Larger defect size and higher TRV were significantly correlated with immediate E/e' elevation.
In older, renal, diastolic, and systolic dysfunctional patients with larger LA and scheduled for larger device implantation, peri-interventional preload reduction therapy would be beneficial.
接受设备封堵房间隔缺损（ASD）的患者年龄不断增加。因此，由于左心室（LV）和左心房（LA）前负荷增加，人们担心设备封堵后呼吸困难加重或发生心房颤动。本研究旨在检查 ASD 设备封堵后肺动脉压和左心室充盈压的系列变化模式及其决定因素。
在 86 例连续接受经皮 ASD 设备封堵的患者中，排除终末期肾病患者或无术前或术后多普勒数据的患者。收集 78 例患者的临床、经食管和经胸超声心动图检查结果，分别在基线、术后 1 天和 1 年随访时进行。
研究患者的平均年龄为 49.8±15.0 岁，平均最大缺损直径和设备大小分别为 20.2±6.0mm 和 23.8±6.4mm。4 例（5.6%）患者发生新发心房颤动，5 例（6.4%）患者在封堵后 1 年内服用利尿剂。一些患者（ = 21；27%）术后 1 天出现三尖瓣反流速度（TRV）反常增加；这些患者年龄较大，e'、肾小球滤过率和 LV 射血分数较低，左房容积指数较高。然而，即使在这些患者中，TRV 在 1 年后也降至基线以下。E/e'和左房容积指数在设备封堵后即刻显著升高，但 1 年后均降低。较大的缺损大小和较高的 TRV 与即刻 E/e'升高显著相关。
对于年龄较大、肾功能不全、舒张和收缩功能障碍、左房较大且计划植入较大设备的患者，围手术期前负荷降低治疗可能有益。
