彩色超声心动图评价房间隔缺损封堵术后右心功能的变化

Evaluation Changes of Right Side of Heart in Transcatheter Closure of Atrial Septal Defect with Color Echocardiography

目的 观察房间隔缺损 (ASD)经右心导管行封堵术后 ,右心房 (RA)、右心室 (RV )形态及功能的变化。方法 86例ASD患者 ,均实施右心导管封堵术。封堵器为Amplatzer式封堵器。术前、术中和术后均经胸壁探查 ,观察心尖四腔心切面 ,比较术前、术后 5min及术后 2月时 ,RA和RV容积大小和形态的变化及三尖瓣返流 (TR)的变化。结果 86例患者术后封堵器位置均良好。其中 83例无明显穿隔血流。 3例因为两孔型ASD封堵其中较大一孔 ,术后 5min残余分流瞬时量平均为 1.6ml。 80例术前与术后 5min比较 ,RA和RV容积明显减小 ,RA容积平均减小了 2 4.4% ,RV容积平均减小了 18.1%。 41例术后 2个月复查 ,其中 3 7例术前轻度肺动脉压力升高者 (小于 45mmHg) ,RA和RV明显减小 ,形态和容积恢复正常。三尖瓣返流明显减少或无。 4例肺动脉压力中至重度升高者 (大于 65mmHg) ,术后RA和RV也有所减小 ,TR减少。结论 ASD经右心导管行封堵术的效果良好。

Objective To observe the shape and function changes of right atrium(RA) and right ventricle(RV) after closure ASD in transcatheter. Methods Eighty six patients with ASD were treated by Amplatzer occluder. After ASD was closed, we compared the volume of RA, RV and tricuspid valve regurgitation(TR) in four chamber view of the apex. Results Eighty six patients were treated successfully.The position and shape of ASD occluder were good. The shunting of eighty three patients with one ASD disappeared after occlusion, the average residual shunting of three patients with two ASD was 1.6ml after occlusion of the bigger ASD.The volume of RA and RV decreased about 24.4% and 18.1% after 5 minutes of occlusion. Two months later fourty one patients were followed up. The volume of RA and RV of thirty seven patients with pulmonary artery high pressure(PH) lower than 45mmHg, decreased to normal degree. TR decreased or disappeared, in four patients with PH higher than 65mmHg, the volume of RA and RV decreased, and TR decreased too. Conclusion The efficacy of ASD occluded by transcatheter is good. The changes of the heart can be confirmed by color echocardiography.