国产封堵器介入治疗房间隔缺损后右心形态和功能的变化

Morphological and functional changes of the right heart after transcatheter closure of atrial septal defects using the domestic-made occluder device

目的:评价国产封堵器介入治疗房间隔缺损(ASD)后右心形态和功能的变化规律。方法:患者41(男15,女26)例,经胸超声(TTE)示ASD最大径5～34(19.4±7.4)mm,选用封堵器型号为8～44(25±9)mm.。术后即刻、2d、3和6月行TTE追踪测量及随访。心尖四腔切面面积—长度法计算右心室容积及射血分数。结果:房缺封堵术后2d及3月随访,右心房上下径、左右径,舒张末期右心室前后径、左右径均进行性减小,与术前比较有显著差异(P<0.05,P<0.01)。术后2d右心室的舒张末期容积较术前明显减小(P<005),右室射血分数逐渐趋于正常。3月右心室的舒张末期容积、收缩末期容积和射血分数进一步改善。3～6月右心房、室大小基本恢复正常。结论:国产封堵器封堵ASD后右心形态和功能的变化规律与Amplatzer封堵器引起的相一致,即在消除异常分流的同时,有效改善右心室容量负荷状态和右心系统的几何构型。

AIM: To evaluate the changes of the right cardiac morphology and right ventricular function after transcatheter closure of atrial septal defect (ASD) using the domestic-made occluder device. METHODS: Forty-one patients with secundum-type ASD (15 male, 26 female) underwent transcatheter closure by using the domestic-made occluder device. Echocardiographic examinations were made immediately, 2 days, 3 months and 6 months after the closure. The right ventricular volume was calculated with plane area length method. RESULTS: Two days after transcatheter closure the right atrium diameter, occipitofrontal diameter and left-right diameter of right ventricles decreased significantly (P<0.05,P<0.01). Right ventricular end-diastolic volume (RVEDV) reduced significantly (P<0.05). And right ventricular ejection fraction (RVEF) had a tendency to normalization. At 3 months RVEDV, RVESV and RVEF improved further. At 3~6 months the right cardiac size is stable on normal level roughly. CONCLUSION: The changes of the right cardiac morphology and right ventricular function after transcatheter closure of ASD using the domestic-made occluder device were similar to that with the Amplatzer occluder device.The domestic-made occluder device not only can eliminate the abnormal shunt, but also can improve the high-volume load of the right heart.