小儿继发孔型房间隔缺损与卵圆孔未闭自然愈合的超声心动图随访

Echocardiographic Follow-up of Spontaneous Closure of Ostium Secundum Atrial Septal Defect and Patent Foramen Ovale in Children

目的:利用彩色多普勒超声心动图对小儿继发孔型房间隔缺损与卵圆孔未闭的自然愈合情况进行随访,比较两者在自然愈合时间和愈合率上的差别。方法:依据房间隔缺损和卵圆孔未闭的判断标准对存在心房间分流的220例新生儿进行超声心动图检查,并将其分成三组:房间隔缺损直径≤3mm组(A组)48例、房间隔缺损直径>3mm组(B组)30例,卵圆孔未闭组(C组)142例,分别对其在出生后6个月、出生后1年、出生后2年进行定期超声随访,记录各组的自然愈合例数并计算出自然愈合率。结果:A组出生后6个月、出生后1年和出生后2年的自然愈合率分别为16.7%(8/48)、52.1%(25/48)、93.8%(45/48);B组分别为:6.7%(2/30)、13.3%(4/30)、23.3%(7/30);C组分别为:80.3%(114/142)、95.1%(135/142)、98.6%(140/142)。对同一时间点上的三组的自然愈合率两两进行卡方检验,出生后6个月时,C组的自然愈合率高于A组和B组(P<0.05),A组和B组比较无统计学意义(P>0.05),出生后1年时,C组高于A组和B组(P<0.05),A组高于B组(P<0.05),出生后2年时,C组和A组均高于B组(P<0.05),A组和C组比较无统计学意义(P>0.05)。结论:继发孔型房间隔缺损在出生后6个月内不容易愈合,当继发型房间隔缺损的直径≤3mm时,其出生后6个月至2年时自然愈合的概率很高,而当缺损的直径>3mm则不容易自然愈合,卵圆孔未闭大多在6个月至1岁时自然愈合,相对房间隔缺损要早一些,然而出生后2年时它与<3mm的继发孔型房间隔缺损的自然愈合率差别不大。

Purpose： Using the color Doppler echocardiography for follow-up examine on spontaneous closure of ostium secundum atrial septal （ASD） defect and patent foramen ovale （PFO） in children, and to compare the different time and rate in spontaneous closure between them. Methods： On the basis of diagnostic criteria for PFO and ASD, the color Doppler echocardiography was used to examine 220 newborns who had the existence of interatrial shunts, and the cases were divided into three groups, Groiap A： 48 cases （ASD, diameters less than or equal to 3mm）, Group B： 30 cases （ASD, diameters greater than 3mm）, Group C： 142 cases （PFO）. Follow-up echocardiography was done on 6 months, 1 year and 2 years after birth, respectively, and each spontaneous closure cases was recorded and then the rates of spontaneous closure were calculated. Results： The rates of spontaneous closure in Group A were 16.7%（8/48）, 52.1%（25/48）, 93.8%（45/48）, respectively; the rates of Group B were 6.7%（2/30）, 13.3%（4/30）,23.3%（7/30）, respectively; the rates of Group C were 80.3%（114/142）,95.1%（135/142）, 98.6%（140/142）, respectively. Chi-square tests were used to analyze every two groups＇ spontaneous closure rate in the same time point. Six months after birth, the rate of Group C was higher than that of Group A and Group B （P〈0.05）. Between Group A and Group B, there was no statistical difference. One year after birth, the rate of Group C was higher than that of Group A and B （P〈0.05）, the rate of Group A was higher than that of Group B （P〈0.05）. Two years after birth, the rates of Group A and Group C were higher than that of Group B （P〈0.05）. Between Group A and Group C, there was no statistical difference. Conclusion： ASD were not easy to close within 6 months after birth. When the defect diameters were less than or equal to 3ram, the rate of spontaneous closure was high within 6 months to 2 years after birth. When the defect diameters were larger than 3ram, the rate of spontaneous closure was low. Most of the PFO were closed within 6 months to 1 year after birth. It was earlier than ASD at the same time. However, there was no significant difference between PFO and ASD with diameters less than or equal to 3ram 2 years after birth.