Hayashi M, Oki T, Iuchi A, Ogawa S, Kageji Y, Hosoi K, Tanimoto M, Fukuda K, Tabata T, Fukuda N
Second Department of Internal Medicine, Tokushima University School of Medicine.
J Cardiol. 1994 May-Jun;24(3):227-36.
The clinical significance of right-to-left (R-L) shunt flow dynamics in atrial septal defects (ASD) were investigated using transesophageal color and pulsed Doppler echocardiography in 30 patients with ASD of the ostium secundum type, including 20 with systolic pulmonary artery pressures (sPA) less than 40 mmHg, 4 with sPA of 40 to 60 mmHg, 3 with sPA of 90 mmHg or greater, 2 with pulmonic stenosis and 1 with Ebstein's anomaly. R-L shunting was detected by a shunt flow signal across the defect during a cardiac cycle. The timing of the R-L shunt was compared with various parameters obtained by echocardiography or cardiac catheterization. R-L shunt flow at the onset of ventricular contraction or closing phase of the tricuspid valve was detected in five patients with isolated ASD associated with increased mean right atrial pressure, but no severe pulmonary hypertension. R-L shunt flow during systole was detected in five of 26 patients with isolated ASD and tricuspid regurgitation and in one patient with Ebstein's anomaly. The tricuspid regurgitation signals in three of the five patients were directed toward the defect, while the other two had massive tricuspid regurgitation. R-L shunt flow during mid-diastole was detected in three patients without pulmonary hypertension. Massive left-to-right shunt flows occurred during the phase from end-systole to early diastole. R-L shunt flow during atrial systole was detected in three patients with severe pulmonary hypertension and two with pulmonic stenosis. The severe pulmonary hypertension patients, in particular, showed the aliasing signal as a high speed shunt flow, and in two of these, R-L shunt flow continued from atrial systole to early ventricular systole, and was also observed in early diastole. R-L shunt flow was detected in ASD patients with and without pulmonary hypertension, and was influenced by right atrial pressure at the phase of tricuspid valve closing, volume or direction of tricuspid regurgitation, rebound flow due to massive left-to-right shunt flow, grade of right ventricular distensibility or pulmonary hypertension, and other cardiac complications.
采用经食管彩色及脉冲多普勒超声心动图，对30例继发孔型房间隔缺损（ASD）患者右向左（R-L）分流血流动力学的临床意义进行了研究，其中包括20例收缩期肺动脉压（sPA）低于40mmHg者、4例sPA为40至60mmHg者、3例sPA为90mmHg或更高者、2例合并肺动脉狭窄者及1例合并埃布斯坦畸形者。通过心动周期中缺损处的分流信号检测R-L分流。将R-L分流的时间与通过超声心动图或心导管检查获得的各种参数进行比较。5例孤立性ASD且平均右心房压力升高但无严重肺动脉高压患者，在心室收缩开始或三尖瓣关闭期检测到R-L分流。26例孤立性ASD合并三尖瓣反流患者中的5例及1例埃布斯坦畸形患者，在收缩期检测到R-L分流。5例患者中有3例的三尖瓣反流信号指向缺损处，而另外2例有大量三尖瓣反流。3例无肺动脉高压患者在舒张中期检测到R-L分流。在收缩末期至舒张早期出现大量左向右分流。3例严重肺动脉高压患者及2例肺动脉狭窄患者在心房收缩期检测到R-L分流。尤其是严重肺动脉高压患者，表现为高速分流的混叠信号，其中2例R-L分流从心房收缩期持续至心室收缩早期，在舒张早期也可观察到。有无肺动脉高压的ASD患者均检测到R-L分流，其受三尖瓣关闭期的右心房压力、三尖瓣反流的容量或方向、大量左向右分流导致的反流、右心室扩张程度或肺动脉高压等级以及其他心脏并发症的影响。
