动脉导管未闭介入封堵术后心功能变化的探讨

Changes of cardiac function after transcatheter closure of Patent Ductus Arteriosus

目的研究动脉导管未闭(PDA)介入封堵术前后及随访期间左右心室功能的变化。方法对20例成功施行经皮穿刺封堵术的PDA患者进行无创心功能研究。所有患者在术前、术后3天、术后1个月、术后3个月、术后6个月分别进行超声心动图检查,观察血流动力学、左右心室大小及功能变化的指标。结果PDA封堵术后右室舒张末期前后径(RVEDD)及容积(RVEDV)、每搏量(RVSV)、射血分数(RVEF)均明显增大(P<0.05),随访中RVEDD和RVEDV进一步增大(P<0.05)。左室舒张末期前后径(LVEDD)及容积LVEDV)、每搏量(LVSV)、射血分数(LVEF)术后均明显减小(P<0.05),随访中上述指标除LVEF外均进一步减小(P<0.05);所有病例术后血流动力学明显改善。结论经皮穿刺封堵术治疗PDA能使血流动力学改变迅速逆转,并能有效地改善患者的左右心室功能。

Objective To evaluate the changes of left and right cardiac function after transcatheter closure of Patent Ductus Arteriosus （PDA） and during a short-term follow-up in 20 patients with PDA. Methods 20 cases with PDA underwent echocardiographic examination before and after transeatheter closure and during a short-term follow-up. There were 7 males and 13 females, aged from 4 to 51 years old. Right ventricular end-diastolic diameter （RVEDD）, right ventricular end-diastolic volume （RVEDV）, right ventricular end -systolic volume （RVESV）, right ventricular stroke volume （RVSV）, right ventricular ejection fraction （RVEF）, left ventricular end-diastolic diameter （LVEDD）, left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV）, left ventricular ejection fraction （LVSV）, left ventricular ejection fraction （LVEF） and the peak flow rate of mitral valve, tricuspid valve and pulmonary valve were respectively measured before and after transeatheter closure and during a short-term follow-up with echocardiographic technique. Right and left ventricular volumes were calculated with the single-plane area-length method. Results RVEDD, RVEDV, RVSV and RVEF increased significantly after transeatheter closure, RVEDD and RVEDV increased further during the follow-up, LVEDD, LVEDV, LVSV and LVEF decreased after transeatheter closure, during the follow-up, LVEDD, LVEDV and LVSV decreased further but LVEF was stable. Conclusion Transcatheter closure, of PDA can not only reverse the abnormal haemodynamies but also effectively improve both left and right cardiac function.