经导管封堵治疗合并肺动脉高压的老年继发孔房间隔缺损

Transcatheter occlusion of secundum atrial septal defect in elderly patients with pulmonary hypertension

目的评估经导管封堵治疗合并肺动脉高压的老年继发孔房间隔缺损(房缺)的疗效和安全性。方法2002年1月-2006年12月于我院行房缺封堵术的34例患者入选本研究,其中15例老年合并肺动脉高压的继发孔房缺患者作为肺动脉高压组。全部患者均在术前、术后1d、1、3、6和12个月行经胸心动超声图和12导联心电图检查。在透视及经胸心动超声图引导下经导管植入Amplatzer封堵器闭合房缺。结果所有患者封堵器植入均获成功,术中和术后均无并发症发生。肺动脉高压组与非肺动脉高压组年龄分别为(67±5)岁和(24±9)岁,(P<0.01),心功能分级分别为2.8±0.7和1.7±0.7,(P<0.01),房缺直径分别为(30.5±3.2)mm和(14.2±4.0)mm(P<0.01),封堵器直径分别为(35.3±4.5)mm和(18.2±4.4)mm(P<0.01),肺动脉收缩压分别为(65.2±11.2)mmHg和(29.5±3.3)mmHg(P<0.01)肺动脉平均压分别为(31.0±4.4)mmHg和(17.9±1.1)mmHg(P<0.01),封堵后,肺动脉高压组患者的肺动脉收缩压为(36.6±11.4)mmHg,肺动脉平均压为(21.6±4.3)mmHg,均有明显下降,两者与术前比较P均<0.01,心功能有明显提高(从术前2.8±0.7增加到1.8±0.8,P<0.01)。结论经导管封堵治疗合并肺动脉高压的老年继发孔房缺安全、有效。

Objective To evaluate the effect and safety of transcatheter occlusion for secundum atrial septal defect （ASD）in elderly patients with pulmonary hypertension. Methods Thirty four patients underwent transcatheter occlusion of ASD from January 2002 to December 2006. Fifteen of them aged over 65 and accompanied with pulmonary hypertension （pulmonary hypertension group）. All patients received thoracic cardiodynamic ultrasonography and 12 leads ECG before and 1 d, 1 mon, 3 mon, 6 mon, 12 mon after the procedure. Under the guidance of fluoroscopy and transthoracic cardio-uhrasonography, Amplatzer occluders was implanted for the atrial septal defect. Results The successful rate of placement of the amplatzer occluder was 100% and no complication was found during the procedure and follow-up period.There were significant differences between pulmonary hypertension group and non-pulmonary hypertension group in age （66.7 ± 5.0y vs 24.1 ± 9.0 y, P 〈 0.001）, classification of heart function（NYHA）（2.8 ± 0.7 vs 1.7 ± 0.7, P 〈 0.001）, diameter of ASD（30.5 ± 3.2 mm vs 14.2 ± 4.0 mm, P 〈 0.001）, size of amplatzer occluder（35.3 ± 4.5 mm vs 18.2 ± 4.4 mm, P 〈 0.001）, systolic pulmonary artery pressure（65.2 ± 11.2 mmHg vs 29.5 ± 3.3 mmHg, P 〈 0.001）and mean pulmonary artery pressure（31.5 ± 4.6 mmHg vs 17.9 ± 1.1 mmHg, P 〈 0.001）. After transcatheter closure of ASD, the parameters the systolic pulmonary artery pressue （36.6 ± 11.4 mmHg）and mean pulmonary artery pressue （21.6 ± 4.3 mmHg）decreased significantly in pulmonary hypertension group compared with those before procedure,and the classification of heart function （NYHA）improved （from 2.8 ± 0.7 to 1.8 ± 0.8, P 〈 0.001 ）. Conclusion Transcatheter occlusion of secundum ASD in elderly patients with pulmonary hypertension is safe and effective.