房间隔缺损Amplatzer封堵术后右心形态和功能改变的超声心动图观察

Echocardiographic morphologic and functional changes of right heart after transcatheter Amplatzer closure of atrial septal defects

目的探讨房间隔缺损行Amplatzer封堵器封堵术后右心形态和功能变化.方法对25例继发孔房间隔缺损患者,分别于术前、术后48～72 h及3个月后行经胸超声心动图检查,测量缺损大小、右心室壁厚度、房室腔径及容积、每搏输出量及射血分数等,并进行比较.结果缺损直径为(2.2±0.6)cm,所有患者均在经胸超声心动图监控下成功植入Amplatzer封堵器;术后48～72 h超声心动图复查,除2例患者残存微量左向右分流外,余患者心房水平分流完全消失;13例患者术后3～6个月复查,原2例残存分流完全消失;术后48～72 h超声心动图检查发现,右心房最大长径及横径,右心室舒张末期长径、横径及前后径,主肺动脉根部内径均明显缩小,右心室舒张末期容积、每搏输出量及射血分数较术前明显减低(P<0.01);术后3个月超声心动图复查发现,患者右心房内径、右心室舒张末期内径及容积、右心室收缩末期横径及容积术后3个月进行性缩小,右心室每搏输出量及射血分数与术后早期相比差异无统计学意义,室间隔异常运动消失.结论房间隔缺损封堵术后右心室前负荷的降低对右心形态有明显影响,右心内径及容积进行性回复,室间隔异常运动消失,代偿增强的右心室每搏输出量、射血分数下降,但并不是持续性降低,而是在新的前负荷水平上达到新平衡,保持右心收缩功能.

Objective To observe the impact of the declined right heart preload on the morphological and functional changes of the right heart after the transcatheter closure of atrial septal defects （ASD） using Amplatzer occluder. Methods Twenty-five subjects with secundum atrial septal defects underwent transthorac echocardiography （TTE） pre-operatively, 48-72 hours and more than three months after operation. The depth of the ventricular walls, the diameters of the right atrial and ventricular chambers and ASD, the stroke volume and ejection fraction of the right ventricle, etc were measured and compared. Results The mean diameter of the ASD was 2. 2 ± 0. 6 cm. All of the patients were implanted one Amplatzer occluder under the guidance of TEE or TIE successfully. Trivial residual shunts were observed in two patients 48-72 hours post-operatively and disappeared after three months. The shunts eliminated completely after the operation in other patients. The echocardiographic re-examination observed the preload of RV was declined 48-72 hours after the operation. The maximum longitudinal dimension and the left-right diameters of the right atrium, the longitudinal, left-right and anteroposterio diameters and the volume at the end diastolic period of the right ventricle were significantly decreased and successively to 3 months post-operatively. The diameter of the main pulmonary artery, the stoke volume and ejection fraction of the right ventricle were reduced significantly at 48-72 hours post-operatively, but had no significant difference between 48-72 hours and after three months. The longitudinal dimension and the volume at the end of the systolic period of the right ventricle were reduced significandy after 3 months. The anomalous movements of the inter-ventricular septum were not found post-operatively. Conclusions The pre-load declined changes of the right heart had significant effect on the morphology of the right heart. After the transcatheter closure of the atrial septal defects with Amplatzer occluder, the over pre-load of the right ventricles disappeared immediately, the diameters and the volumes of the right heart were decreased constantly, the anomalousmovement of the inter-ventricular septum disappeared, the geometry of the right ventricle was improved, the complementary increased stroke volume and the ejection fraction of the right ventricle were reduced and a new balance at a new pre-load level were obtained but not successively. The systolic function of the right ventricle was remained.