不同年龄房间隔缺损封堵术后心脏电生理及几何形态的变化

Electrical and geometric changes after percutaneous closure of atrial septal defect

目的:了解不同年龄患者经导管房间隔缺损(ASD)堵闭术后心脏电生理及几何形态的变化。方法:100例ASD患者,按年龄分为儿童组和成人组,对比研究其经导管堵闭术前及术后1 d、1个月、3个月心电图(ECG)及经胸超声心动图(TTE)测量指标的变化,ECG指标包括P-R间期、QRS时限、II导联P波振幅(PII)、RV1+SV5等,TTE指标有右心室舒张末期内径(RVDD)、左心室舒张末期内径(LVDD)、右室/左室(RVDD/LVDD)比率、收缩末期左房横径(LALD)、右房横径(RALD)、RALD/LALD及左室射血分数(LVEF)等。结果:儿童组患者术后1 d与术前相比,RALD由(36±7)mm降至(34±8)mm,RVDD由(30±8)mm降至(26±7)mm,LVEF由(64±7)%升至(69±6)%;术后1个月时,LALD由(29±7)mm增至(32±8)mm,LVDD由(36±6)mm升至(39±6)mm;术后3个月时,P-R间期由(136±20)ms降至(125±13)ms,以上指标均有统计学意义;成人组与儿童组变化相似;两组的QRS时限、PII和RV1+SV5至术后3个月时仍无显著变化。结论:继发孔型房间隔缺损的介入治疗减轻了右心的容量负荷,使心脏的电生理改变恢复正常,逆转了心脏重构,对不同年龄的患者均有良好效果。

Objective： To investigate the electrical and geometric changes of heart after pereutaneous closure of atrial septal defect （ASD）. Methods： A total of 100 patients received pereutaneous closure of ASD, and were measured standard 12-lead electrocardiography （ECG） and transthomcic echocardiography（TIE） before closure, 24 hours, 1 month and 3months after closure. The items of ECG included P-R interval, QRS duration, （PⅡ）andRⅤ1,＋SⅤ5, and that of TIE included the diastolic diameter of right ventricle（RVDD） and left ventricle（LVDD）, RVDD/ LVDD ratio, the lateral diameter of left atrial （LALD） , the lateral diameter of right atrial （RALD）, RALD/LAID ratio and ejection fmetion（EF） of LV. Results： In all patients, the P-R interval, RVDD, RALD, RVDD/LVDD and RALD/LALD ratio decreased and LVDD, LALD, EF increased significantly after closure, but QRS duration,（PⅡ）and RⅤ1,＋SⅤ5 were not significantly different. Conclusion： Transcatheter closure of ASD is safe and effective for all patients of different ages, and the electrical and geolnetric changes of heart normalize after closure, indicating that the volume load of right ventricle is decreased.