经皮室间隔缺损封堵术对左心室重构及功能的影响。
Impact of percutaneous ventricular septal defect closure on left ventricular remodeling and function.
作者信息
Aal Amr Abdel, Hassan Housam M, Ezzeldin Dina, El Sayed Maiy
机构信息
Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
出版信息
Egypt Heart J. 2021 Oct 12;73(1):86. doi: 10.1186/s43044-021-00215-z.
BACKGROUND
Ventricular septal defect (VSD) is the most common congenital heart disease. In patients with large VSD, left side chambers are subjected to volume overload with subsequent chambers dilatation and eccentric left ventricular hypertrophy. Percutaneous closure of VSD has been shown to be an effective method with equal safety and efficacy when compared to surgery. The effect of VSD closure on LV remodeling has been mainly assessed in patients treated with surgery and to date published data remain scarce. Therefore, we aim to evaluate the effect of percutaneous VSD closure on different LV parameters.
RESULTS
Seventeen patients (median age 6 years (IQR 4.75-8 years), 70.6% females) who underwent percutaneous VSD closure were enrolled in the study. Sixteen patients (94%) had perimembranous VSD, and one patient had muscular VSD. The procedure was successful in all patients with no major complications. Nit Occlud® Lê coil device was implanted in 16 patients (94%), and one patient received Amplatzer PDA duct occlude device. At 6-months follow-up, there was a significant reduction in indexed LV dimensions [LVEDD/BSA (median 46.5 mm/m vs. 42.9 mm/m, p = 0.03), LVESD/BSA (median 31.7 mm/m vs. 26.7 mm/m, p = 0.02)], indexed LV volumes [LVEDV/BSA (median 52.6 ml/m vs. 37.3 ml/m, p = 0.02), LVESV/BSA (median 31.7 ml/m vs. 23.3 ml/m, p = 0.02)] and indexed LV mass (median 62.4 gm/m vs. 57.9 ml/m, p = 0.01). There was a significant reduction in LVEDD Z-score (p = 0.01) and LVESD Z-score (p = 0.04). There was no significant change in LV EF.
CONCLUSIONS
Percutaneous VSD closure is associated with improvement of various LV parameters with consequential favorable LV remodeling and function.
背景
室间隔缺损（VSD）是最常见的先天性心脏病。在大型VSD患者中，左心腔承受容量超负荷，随后心腔扩张并出现偏心性左心室肥厚。与手术相比，经皮封堵VSD已被证明是一种安全有效的方法。VSD封堵对左心室重塑的影响主要在接受手术治疗的患者中进行了评估，迄今为止公布的数据仍然很少。因此，我们旨在评估经皮VSD封堵对不同左心室参数的影响。
结果
17例接受经皮VSD封堵的患者（中位年龄6岁（四分位间距4.75 - 8岁），70.6%为女性）纳入本研究。16例患者（94%）为膜周部VSD，1例为肌部VSD。所有患者手术均成功，无重大并发症。16例患者（94%）植入了Nit Occlud® Lê线圈装置，1例患者接受了Amplatzer PDA封堵器。在6个月的随访中，左心室指数尺寸[左心室舒张末期内径/体表面积（中位值46.5 mm/m对42.9 mm/m，p = 0.03），左心室收缩末期内径/体表面积（中位值31.7 mm/m对26.7 mm/m，p = 0.02）]、左心室指数容积[左心室舒张末期容积/体表面积（中位值52.6 ml/m对37.3 ml/m，p = 0.02），左心室收缩末期容积/体表面积（中位值31.7 ml/m对23.3 ml/m，p = 0.02）]和左心室指数质量（中位值62.4 gm/m对57.9 ml/m，p = 0.01）均显著降低。左心室舒张末期内径Z评分（p = 0.01）和左心室收缩末期内径Z评分（p = 0.04）显著降低。左心室射血分数无显著变化。
结论
经皮VSD封堵与各种左心室参数的改善相关，从而有利于左心室重塑和功能。
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