超声心动图评价房间隔缺损合并肺动脉高压者封堵术后心脏形态学变化

Changes in cardiac morphology of patients with atrial septal defect combing pulmonary hypertension underwent transcatheter closure evaluated by echocardiography

目的：探讨超声心动图评价房间隔缺损（ASD），尤其是合并肺动脉高压者介入封堵术后心脏结构及功能改变的价值。方法经超声心动图确诊为ASD并成功施行封堵术的患者109例，肺动脉压力正常者55例，轻度肺动脉高压者（PASP，35～50 mmHg）25例，中度肺动脉高压者（PASP，50～70 mmHg）17例，重度肺动脉高压（PASP〉70 mmHg）者12例。分别于封堵术前3 d，术后3 d、1个月、3个月、6个月行超声心动图检查，测量心脏结构及心功能。结果肺动脉压力正常者及轻度肺动脉高压者，与术前相比，术后3d右心房、右心室和肺动脉内径减小（P〈0.05），肺动脉瓣口血流速度降低，左心室内径增大，左心房和主动脉内径在术后1个月增大（P〈0.05），在后期随访中上述变化逐渐趋于稳定；中度肺动脉高压者与术前相比，右心房和右心室内径在术后3个月时变化差异有统计学意义（P〈0.05），左心室和左心房分别在术后3个月、6个月时变化差异有统计学意义（P〈0.05）；重度肺动脉高压者与术前相比，左心房和左心室内径在6个月时变化差异有统计学意义（P〈0.05），但右心房、右心室、主动脉及肺动脉内径变化差异均无统计学意义（P〉0.05）。结论中重度肺动脉高压ASD患者，通过封堵术可增加患者手术机会，但其心脏结构恢复时间长且效果差。

Objective To explore the clinical value of echocardiography in evaluating the changes in cardiac morphology and function of patients with atrial septal defect underwent transcatheter closure, especially when combined with pulmonary hypertension. Methods A total of 109 patients with ASD diagnosed by echocardiography who have had the operation of transcather closure were enrolled. They were divided into normal pulmonary artery pressure group （n=55）, mild pulmonary hypertension group （PASP, 35～50 mmHg, n=25）, moderate pulmonary hypertension group （PASP, 50～70 mmHg, n=17） and severe pulmonary hypertension group （PASP〉70 mmHg, n=12）. The echocar-diographic examination was carried out 3 days before the operation, 3 days after the operation, 1 month, 3 months and 6 months after the operation respectively, to evaluate the morphology and function of heart. Results In normal pulmonary artery pressure group and mild pulmonary hypertension group, the diameters of right atrium, right ventricle, pulmonary artery and the blood flow of pulmonary valve decreased 3 days after the operation （P〈0.05）. The diameter of left ventricle increased 3 days after the operation;while the diameters of left atrium and aorta increased 1 month after the operation （P〈0.05）. These changes remained relatively stable in late follow-ups. In moderate pulmonary hypertension group, the diameters of right atrium, right ventricle decreased 3 months after the operation （P〈0.05）. The diameter of left ventricular increased 3 months after the operation （P〈0.05） while the diameter of left atrium increased 6 months af-ter the operation （P〈0.05）. In severe pulmonary hypertension group, the diameters of left atrium and left ventricle increased 6 months after the operation （P〈0.05）, while the changes of other diameters were of no significant differences （P〉0.05）. Conclusion The ASD patients with moderate to severe pulmonary hypertension have an opportunity of operation through transcatheter closure, but it is difficult and time-consuming for the heart structure to recover.