超声心动图评价房间隔缺损封堵术后心脏结构和心功能变化

摘要

目的：探讨超声心动图评价房间隔缺损（ASD）患者经导管封堵术后心脏结构、血流动力学和心功能的变化。方法经胸超声心动图检查确诊为ASD的患者120例，男性35例，女性85例，年龄3～73岁，平均年龄（27.3±18.9）岁；缺损直径为5～34 mm，平均直径为（17.5±7.4）mm。成功施行ASD封堵术的患者118例。分别于术前、术后48小时、术后1个月、术后3个月、术后6个月及术后1年，采用经胸超声心动图（TTE）测定其心脏结构、血流动力学及心功能指标。结果术后48小时后左室内径、左室射血分数较术前增加，比较差异具有显著性（P ＜0.05）；术后48小时后右房内径、右室内径、肺动脉内径较术前减小，术后1个月较术后48小时继续减小，比较差异均具有显著性（P ＜0.05）；术后48小时后肺动脉瓣口血流速度、肺动脉收缩压较术前减小，比较差异具有显著性（P ＜0.05）。结论 ASD 封堵术不仅可以有效根治先天性解剖畸形，而且在早期可以迅速纠正血流动力学异常，改善心脏几何构型和心功能。%Objective To carry out the postoperative follow-up study after the transcatheter closure of atrial septal defect (ASD);to observe the changes of the cardiac morphology, cardiac hemodynamic and cardiac function by using Transthoracic Echocardiography (TTE). Method 120 cases of patients were brought into the whole group, including the male 35, the female 85, aged from 3~73 (27.3±18.9) years old, ranged from 5~34 (17.5±7.4) mm of the diameter of ASD. To measure the indexes of the cardiac morphology, the cardiac hemodynamic and the cardiac function, including the diameter of left ventricle, left atrial, right ventricle, right atrium, pulmonary artery, right ventricular outlfow tract, aortic valve blood lfow velocity, mitral valve blood lfow velocity, tricuspid valve blood lfow velocity, pulmonary valve blood lfow velocity, left ventricular ejection fractional, systolic pulmonary artery pressure by Transthoracic Echocardiography (TTE) in preoperative. Follow-up was performed in 48 hours, one month, three months, six months, one year after the transcatheter occlusion. Result The diameter of left ventricle, left ventricular ejection fractional increased significantly 48 hours after the procedure (P < 0.05);the diameter of right atrium, right ventricle and pulmonary artery decreased signiifcantly from 48 hours to one month after the procedure (P<0.05). Pulmonary valve blood lfow velocity and systolic pulmonary artery pressure decreased signiifcantly 48 hours after the procedure (P<0.05). Conclusion Transcatheter closure of ASD not only cure effectively congenital anatomic deformity, but also correct hemodynamic abnormalities rapidly in the early;meanwhile reconstruct right and left heart geometry and improve the heart function signiifcantly.