先天性心脏病ASD介入封堵治疗术后右心结构改变及安全性的比较

The comparison of right ventricular structure and safety on intervening closure of atrial septal defects in congenital heart disease

目的观察先天性心脏病房间隔缺损（ASD）介入封堵术对儿童（〈15岁）及成人（15～65岁）右心结构的影响及安全性评估。方法回顾分析该院2010～2013年111例行介入治疗的ASD患者，采用心脏彩超测量结果评估封堵前后儿童与成人右心结构变化，采用心脏彩超、心电图记录封堵器脱落、瓣膜关闭不全、心律失常、残余分流等并发症的发生情况。结果与术前比较，儿童及成人术后右心房内径（RAD）、右心室内径（RVD）、肺动脉内径（PA）、右心室流出道（RVOT）均明显减小（P〈0．05），随访过程中小于15岁年龄组在1、3、6个月以上指标差异无统计学意义（P〉0．05），15～65岁年龄组在1、3、6个月以上指标差异有统计学意义（P〈0．05）。儿童及成人并发症发生率分别为25．0％和21．3％，两组并发症发生率差异无统计学意义（P〉0．05），未见严重并发症。结论ASD介入可改善右心结构，儿童和成人均能受益，且儿童和成人并发症发生率没有明显差异，严重并发症少，安全性高，疗效肯定。

Objective To observe the influence of congenital heart disease（atrial septal defect,ASD） to intervene closure on the right structure of children（〈15 years） and adults（15--65 years） and to make the safety assessment. Methods Totally 111 underwent interventional treatment of complications in patients with ASD in our hospital from 2010 to 2013 were retrospective analyzed. Closure on changing of right heart structure of child and adult were measured by ultrasonic cardiogram. Closure falls off, shut valve insufficiency,arrhythmia,residual shunt were recorded by ultrasonic cardiogram and electrocardiogram, making statistical analysis. Results The inner diameter of the right atrium（RAD）, right ventricle diameter （RVD）, pulmonary artery diameter （PA） and right ventricular outflow tract（RVOT） were decreased compared with pre-operation（P〈0.05）, during the follow-up 1,3,6 month,they was continue decreased in the aged between15 -- 65 group（P〈0.05） ,hut was stable in less than 15 years old age group （P〉0.05）. The complication rate of children and adults were 25.0% and 21.3% respectively, and there were no significantly difference（P〉0.05） ,and was no serious complications. Conclusion Congenital heart disease intervention of atria septal defects can improve heart right structure, which can benefit both children and adult, there is no difference in complication rates. All of these have less serious complications, high safety, curative effect affirmation.