CAJ | 학술논문

目的探讨经导管介入封堵术治疗继发孔型房间隔缺损(ASD)的封堵器选择对其疗效及心脏形态学重构的影响.方法入选146例ASD患者,年龄13.5～70.0(33.5±12.4)岁.其中73例(A组)根据椭圆周长数学公式计算缺损直径选择封堵器型号,另外73例(B组)根据超声心动图测量长径选择封堵器型号.应用经胸超声心动图分别测量ASD患者经导管封堵治疗术前、术后3 d、3个月和6个月的左心房收缩末期横径(LALD)、右心房横径(RALD)、RALD/LALD比值、右心室舒张末期内径(RVDD)、左心室舒张末期内径(LVDD)、RVDD/LVDD比值及肺动脉内径.结果 A组缺损内径为(20.16±4.98)mm,B组为(21.36±5.69)mm,差异无统计学意义.封堵器直径A组小于B组[(21.95±6.78)mm比(25.85±6.75)mm,P<0.05].142例封堵术成功,两组成功率差异无统计学意义,无主要手术相关并发症发生.随访6个月无残余分流发生.两组患者随访期间RALD、RVDD、RALD/LALD和RVDD/LVDD比值明显下降,肺动脉内径逐渐缩小,LALD、LVDD逐渐增大.A组改善心房重构程度明显大于B组(P<0.05).结论椭圆形周长公式在非圆形ASD封堵器选择中具有重要应用价值;封堵器大小对心脏重构有明显影响.
목적 탐토경도관개입봉도술치료계발공형방간격결손(ASD)적봉도기선택대기료효급심장형태학중구적영향.방법 입선146례ASD환자,년령13.5～70.0(33.5±12.4)세.기중73례(A조)근거타원주장수학공식계산결손직경선택봉도기형호,령외73례(B조)근거초성심동도측량장경선택봉도기형호.응용경흉초성심동도분별측량ASD환자경도관봉도치료술전、술후3 d、3개월화6개월적좌심방수축말기횡경(LALD)、우심방횡경(RALD)、RALD/LALD비치、우심실서장말기내경(RVDD)、좌심실서장말기내경(LVDD)、RVDD/LVDD비치급폐동맥내경.결과 A조결손내경위(20.16±4.98)mm,B조위(21.36±5.69)mm,차이무통계학의의.봉도기직경A조소우B조[(21.95±6.78)mm비(25.85±6.75)mm,P<0.05].142례봉도술성공,량조성공솔차이무통계학의의,무주요수술상관병발증발생.수방6개월무잔여분류발생.량조환자수방기간RALD、RVDD、RALD/LALD화RVDD/LVDD비치명현하강,폐동맥내경축점축소,LALD、LVDD축점증대.A조개선심방중구정도명현대우B조(P<0.05).결론 타원형주장공식재비원형ASD봉도기선택중구유중요응용개치;봉도기대소대심장중구유명현영향.
Objective To evaluate the effects on cardiac remodeling post transcatheter closure by Amplatzer septal occluder selected by oval circumference formula in patients with atrial septal defect (ASD). Methods A total of 146 patients with ASD (68 males,mean 33.5 years) treated by transcatheter closure with the Amplatzer oceluder were enrolled in this study. The diameter of defects was corrected with the oval circumference formula (group A, 73 cases) or by echocardiography (group B, 73 cases). Cardiac remodeling was assessed by transthoracie echocardiography (TIE) before the procedure, 3 days, 3 months and 6 months after ASD closure. Results The mean ASD diameter was similar between the two groups [(20.16±4.98) mm vs. (21.36±5.69) mm, P > 0.05] and the mean diameter of the selected occluder of group A was significantly smaller than that in group B [(21.95±6.78)mm vs. (25.85±6.75)mm, P< 0.05]. Procedural success rate was identical between the two groups (97.3%) and the defects were completely occluded and there was no residual shunt during the 6 months follow up period, there were also no complications during and after the procedure. The lateral diameter of right atrial (RALD), the diastolic diameter of right ventricle (RVDD), RALD/LALD, RVDD/LVDD and pulmonary diameter (PD) were significantly decreased while the lateral diameter of left atrial (LALD) and left ventricle (LVDD) were significantly increased post ASD closure in both groups. At 6 months follow up, BALD decreased by (18.63±10.59) % in group A versus (10.14±6.59) % in group B, LALD increased by (13.42± 8.38) % in group A versus (9.28±4.95) % in group B and RALD/LALD ratio decreased by (26.35± 11.24)% in group A versus (13.98±8.96) % ingroupsB (all P<0.05).Conclusion ASD occluder selection based on the oval circumference formula is superior to that made by echocardiography in terms of more favorable cardiac remodeling post ASD closure.