Søndergård T, Paulsen P K
Circulation. 1984 May;69(5):905-13. doi: 10.1161/01.cir.69.5.905.
The circumclusion method for surgical closure of atrial septal defects (ASDs) of the secundum type makes it possible, during surgery, to close and reopen the defect as desired. In each of 23 patients the following statistically significant pressure and flow changes were found when the ASD was closed: increasing mean pressures in the ascending aorta (from 74 to 87 mm Hg), left atrium (from 10 to 18 mm Hg), and right pulmonary artery (from 20 to 24 mm Hg); increasing mean flows in the ascending aorta (from 84 to 111 ml/min/kg); decreasing mean pressures in the right atrium (from 9.0 to 7.7 mm Hg); and decreasing mean flows in the right pulmonary artery (from 78 to 46 ml/min/kg). Surprisingly, no correlation between shunt size determined before and during surgery was found. However, in the calculation of the intraoperative shunt, several factors might have contributed to an erroneous result. In 17 patients a right heart catheterization was performed in the third to thirteenth postoperative month and the following statistically significant changes from the intraoperative results with closed ASD were found: The intraoperative mean pressure in the left atrium (18 mm Hg) decreased to 7.3 mm Hg after surgery (pulmonary wedge pressure), the pulmonary arterial pressure decreased from 23 to 13 mm Hg, and the right atrial pressure from 8.2 to 1.6 mm Hg.
继发孔型房间隔缺损（ASD）手术闭合的包绕法使得在手术过程中能够根据需要闭合和重新打开缺损。在23例患者中，当ASD闭合时，均发现了以下具有统计学意义的压力和血流变化：升主动脉平均压力升高（从74 mmHg升至87 mmHg）、左心房平均压力升高（从10 mmHg升至18 mmHg）、右肺动脉平均压力升高（从20 mmHg升至24 mmHg）；升主动脉平均血流增加（从84 ml/min/kg增至111 ml/min/kg）；右心房平均压力降低（从9.0 mmHg降至7.7 mmHg）；右肺动脉平均血流降低（从78 ml/min/kg降至46 ml/min/kg）。令人惊讶的是，术前和术中确定的分流大小之间未发现相关性。然而，在术中分流的计算中，几个因素可能导致了错误的结果。17例患者在术后第3至13个月进行了右心导管检查，发现与ASD闭合时的术中结果相比，有以下具有统计学意义的变化：术后左心房术中平均压力（18 mmHg）降至7.3 mmHg（肺楔压），肺动脉压力从23 mmHg降至13 mmHg，右心房压力从8.2 mmHg降至1.6 mmHg。
