CAJ | 학술논문

目的：探讨超声心动图评价房间隔缺损(ASD)，尤其是合并肺动脉高压者介入封堵术后心脏结构及功能改变的价值。方法经超声心动图确诊为ASD并成功施行封堵术的患者109例，肺动脉压力正常者55例，轻度肺动脉高压者(PASP，35~50 mmHg)25例，中度肺动脉高压者(PASP，50~70 mmHg)17例，重度肺动脉高压(PASP>70 mmHg)者12例。分别于封堵术前3 d，术后3 d、1个月、3个月、6个月行超声心动图检查，测量心脏结构及心功能。结果肺动脉压力正常者及轻度肺动脉高压者，与术前相比，术后3d右心房、右心室和肺动脉内径减小(P<0.05)，肺动脉瓣口血流速度降低，左心室内径增大，左心房和主动脉内径在术后1个月增大(P<0.05)，在后期随访中上述变化逐渐趋于稳定；中度肺动脉高压者与术前相比，右心房和右心室内径在术后3个月时变化差异有统计学意义(P<0.05)，左心室和左心房分别在术后3个月、6个月时变化差异有统计学意义(P<0.05)；重度肺动脉高压者与术前相比，左心房和左心室内径在6个月时变化差异有统计学意义(P<0.05)，但右心房、右心室、主动脉及肺动脉内径变化差异均无统计学意义(P>0.05)。结论中重度肺动脉高压ASD患者，通过封堵术可增加患者手术机会，但其心脏结构恢复时间长且效果差。
목적：탐토초성심동도평개방간격결손(ASD)，우기시합병폐동맥고압자개입봉도술후심장결구급공능개변적개치。방법경초성심동도학진위ASD병성공시행봉도술적환자109례，폐동맥압력정상자55례，경도폐동맥고압자(PASP，35~50 mmHg)25례，중도폐동맥고압자(PASP，50~70 mmHg)17례，중도폐동맥고압(PASP>70 mmHg)자12례。분별우봉도술전3 d，술후3 d、1개월、3개월、6개월행초성심동도검사，측량심장결구급심공능。결과폐동맥압력정상자급경도폐동맥고압자，여술전상비，술후3d우심방、우심실화폐동맥내경감소(P<0.05)，폐동맥판구혈류속도강저，좌심실내경증대，좌심방화주동맥내경재술후1개월증대(P<0.05)，재후기수방중상술변화축점추우은정；중도폐동맥고압자여술전상비，우심방화우심실내경재술후3개월시변화차이유통계학의의(P<0.05)，좌심실화좌심방분별재술후3개월、6개월시변화차이유통계학의의(P<0.05)；중도폐동맥고압자여술전상비，좌심방화좌심실내경재6개월시변화차이유통계학의의(P<0.05)，단우심방、우심실、주동맥급폐동맥내경변화차이균무통계학의의(P>0.05)。결론중중도폐동맥고압ASD환자，통과봉도술가증가환자수술궤회，단기심장결구회복시간장차효과차。
Objective To explore the clinical value of echocardiography in evaluating the changes in cardiac morphology and function of patients with atrial septal defect underwent transcatheter closure, especially when com-bined with pulmonary hypertension. Methods A total of 109 patients with ASD diagnosed by echocardiography who have had the operation of transcather closure were enrolled. They were divided into normal pulmonary artery pressure group (n=55), mild pulmonary hypertension group (PASP, 35~50 mmHg, n=25), moderate pulmonary hypertension group (PASP, 50~70 mmHg, n=17) and severe pulmonary hypertension group (PASP>70 mmHg, n=12). The echocar-diographic examination was carried out 3 days before the operation, 3 days after the operation, 1 month, 3 months and 6 months after the operation respectively, to evaluate the morphology and function of heart. Results In normal pulmo-nary artery pressure group and mild pulmonary hypertension group, the diameters of right atrium, right ventricle, pulmo-nary artery and the blood flow of pulmonary valve decreased 3 days after the operation (P<0.05). The diameter of left ventricle increased 3 days after the operation;while the diameters of left atrium and aorta increased 1 month after the op-eration (P<0.05). These changes remained relatively stable in late follow-ups. In moderate pulmonary hypertension group, the diameters of right atrium, right ventricle decreased 3 months after the operation (P<0.05). The diameter of left ventricular increased 3 months after the operation (P<0.05) while the diameter of left atrium increased 6 months af-ter the operation (P<0.05). In severe pulmonary hypertension group, the diameters of left atrium and left ventricle in-creased 6 months after the operation (P<0.05), while the changes of other diameters were of no significant differences (P>0.05). Conclusion The ASD patients with moderate to severe pulmonary hypertension have an opportunity of oper-ation through transcatheter closure, but it is difficult and time-consuming for the heart structure to recover.