Steele P M, Fuster V, Cohen M, Ritter D G, McGoon D C
Department of Medicine, Mount Sinai School of Medicine of the City University of New York, New York.
Circulation. 1987 Nov;76(5):1037-42. doi: 10.1161/01.cir.76.5.1037.
We examined the cases of 702 patients found to have isolated atrial septal defect of the secundum or sinus venosus type at catheterization from 1953 to 1978. Forty patients (6%), 34 women and six men, had pulmonary vascular obstructive disease, with a total pulmonary resistance greater than 7 U/m2; of these patients 26 (mean age 47 years) underwent surgical closure and 14 (mean age 44 years) received medical treatment. All patients were followed for at least 4 years, with a median follow-up of 12 years. At the most recent follow-up, 17 of the 40 patients were dead. Of the 22 surgically treated patients with total pulmonary resistance less than 15 U/m2, 19 were alive with significant regression of symptoms. All four surgically treated patients with total pulmonary resistance greater than or equal to 15 U/m2 were dead. Of the five medically treated patients with total pulmonary resistance less than 15 U/m2, four had died, and one was alive with significant progression of symptoms. Of the nine medically treated patients with total pulmonary resistance greater than or equal to 15 U/m2, six had died and the three survivors had progression of symptoms. In the surgically treated group, the following variables correlated with survival: total pulmonary resistance (p less than .00001), pulmonary arteriolar resistance (p less than .00001), pulmonary-to-systemic resistance ratio (p = .004), systemic arterial oxygen saturation (p = .005), and pulmonary arterial oxygen saturation (p = .007).
(1) Atrial septal defect with high total pulmonary resistance is uncommon and predominates in adult female patients.(ABSTRACT TRUNCATED AT 250 WORDS)
我们研究了1953年至1978年期间在导管检查中发现患有继发孔型或静脉窦型孤立性房间隔缺损的702例患者的病例。40例患者（6%），34名女性和6名男性，患有肺血管阻塞性疾病，总肺阻力大于7U/m²；这些患者中26例（平均年龄47岁）接受了手术闭合，14例（平均年龄44岁）接受了药物治疗。所有患者均随访至少4年，中位随访时间为12年。在最近的随访中，40例患者中有17例死亡。在22例手术治疗且总肺阻力小于15U/m²的患者中，19例存活且症状明显缓解。4例手术治疗且总肺阻力大于或等于15U/m²的患者均死亡。在5例药物治疗且总肺阻力小于15U/m²的患者中，4例死亡，1例存活且症状明显进展。在9例药物治疗且总肺阻力大于或等于15U/m²的患者中，6例死亡，3例存活且症状进展。在手术治疗组中，以下变量与生存相关：总肺阻力（p＜0.00001）、肺小动脉阻力（p＜0.00001）、肺循环与体循环阻力比值（p = 0.004）、体动脉血氧饱和度（p = 0.005）和肺动脉血氧饱和度（p = 0.007）。
（1）总肺阻力高的房间隔缺损并不常见，且在成年女性患者中占主导。（摘要截短至250字）
