年龄≥60岁的房间隔缺损患者的介入封堵治疗

Transcatheter closure of atrial septal defect in patients over 60 years old

目的：探讨年龄≥60岁的房间隔缺损（atrial septal defect,ASD）患者介入封堵治疗的安全性和有效性。方法：分析51例拟行ASD介入封堵术的年龄≥60岁患者的临床资料特征及手术效果,并与其他年龄段的成人ASD进行比较。结果：年龄≥60岁的ASD患者（60ASD）占成人ASD的7.9%（51/647例）。60ASD的房颤发生率（27.45%）明显高于18~60岁的ASD患者（59ASD）（3.52%）。60ASD与59ASD患者相比：心脏结构的重构改变更加明显,包括心房和心室增大更多,心腔内压力和肺血管阻力明显增高。但相关性分析显示,ASD患者年龄与肺动脉压力、左房内径、右房内径、左室舒张末内径、右室舒张末内径和肺阻力仅有较弱相关性（r分别为：0.263、0.500、0.215、0.174、0.153、0.335）。60ASD与59ASD患者的手术成功率和主要并发症发生率无差别。不论任何年龄段的患者,术后右心重构均明显改善,表现在右房右室过度充盈减轻,内径缩小;但是60ASD患者心脏重构的改善程度小于59ASD。结果：介入封堵治疗年龄≥60岁的ASD患者安全有效,术后患者心脏重构改善。

Objective：To evaluate the safety and effect of transcatheter closure of atrial septal defect（ASD）in patients aged over 60 years old. Methods：Fifty-one over 60-year-old patients underwent transcatheter ASD closure,and their clinic data and procedural outcome were analyzed in this study. Meanwhile,all the data and outcomes were compared with other age groups. Results：Patients above 60 years old with ASD（60ASD）accounted about 7.9%（51 / 647）of adult ASD patients. The incidence of atrial fibrillation in60ASD（27.45%）was significantly higher than that of ASD patients aged 18~60 years（59ASD）（3.52%）. Compared with 59 ASD,the cardiac remodeling showed more obvious effects in 60 ASD. Those effects included atrial and ventricular enlargement,increasing atrioventricular chamber pressure and pulmonary vascular resistance. However, the correlation analysis suggested there was weak correlation between age and pulmonary arterial pressure,left atrial diameter,right atrial diameter,left ventricular end diastolic diameter,right ventricular diastolic diameter,and pulmonary resistance（r =0.263,0.5,0.215,0.174,0.153,0.335,respectively）.Successful rates of procedure and major complications didn’t show significant difference between 60 ASD and 59 ASD. Right cardiac remodeling after procedure was significant,as the right atrial / ventricular overload was alleviated and diameter was reduced no matter which age group was the patient in. However,the improvement of 60 ASD cardiac remodeling was less than 59 ASD. Conclusion：Transcatheter ASD closure is effective and safe among ASD patients over 60 years old.