婴幼儿动脉导管未闭介入封堵前后左室收缩功能及电压变化

Changes of left ventricular systolic function and voltage before and after transcatheter closure of persistent ductus arteriosus in infants

目的观察婴幼儿动脉导管未闭(PDA)封堵前后左室收缩功能和电压的变化。方法对29例患儿采取主动脉弓降部侧位造影,确定动脉导管形态,测量最窄处直径,选择合适封堵器,经静脉途径植入封堵器。术前、术后3天内行心脏超声和心电图检查,比较封堵前后左室射血分数(EF)和短轴缩短率(FS),RV5(V5导联R波)及RV5+SV1(V1导联S波)。结果封堵后反应左室收缩功能的指标EF和FS均较封堵前显著下降(P<0.01),但临床观察并无左室功能不全症状出现;反应左室电压的指标Rv5和Rv5+Sv1数值封堵后虽然较封堵前降低,但差异无统计学意义(P>0.05)。结论婴幼儿动脉导管未闭封堵后一定时期内,不能根据EF和FS值的变化趋势来评价左室收缩功能状态。

Objective To observe changes of left ventricular systolic function and voltage before and after transcatheter closure of persistent ductus arteriosus（PDA） in infants.Methods From January 2006 to October 2008,twenty-nine infants suffer from PDA with 14 boys and 15 girls,an average age of 1.28±0.67 years and weight of 8.96±2.34 kg,were included.According to the lateral descending aortographies,determination of shape,measurement of diameter at narrowest segment and selection of suitable occluder of PDA were performed.Occluder was implanted using the anterograde venous approach.Values of left ventricular ejection fraction（EF） and shortening fraction（FS）,lead V5 R（RV5） and RV5＋SV1 were derived,echocardiography and EKG testing were performed in three days before and after operation.The values were compaired between pre and post operation.Results After closure,EF and FS relating to left ventricular systolic function decreased significantly （P0.01）but with no symptoms of left ventricular dysfunction appearing;Rv5 and Rv5＋Sv1,relating to left ventricular voltage,also decreased slightly,but without significant difference.Conclusion In a certain period of time after transcatheter closure of PDA in infants,the left ventricular systolic function can＇t be evaluated by the variation trend of EF and FS.