经皮左心耳封堵术后医源性房间隔缺损的自然史及影响因素分析

Natural outcome of spontaneous closure of iatrogenic atrial septal defect percutaneous left atrial appendage occlusion and its influencing factors

目的探讨心房颤动患者行经皮左心耳封堵术医源性房间隔缺损(iatrogenic atrial septal defect,IASD)的自然闭合史及其影响因素。方法选取2014年9月—2018年2月行经皮导管左心耳封堵术后122例患者进行观察及随访,分别于术前,术后45 d、3个月、6个月、1年行经胸超声心动图及经食道超声心动图检查,内容包括房室大小、心功能及房间隔缺损大小。分析患者IASD愈合的自然史发展史、IASD愈合的影响因素及预后。结果随着随访时间延长,愈合率逐渐升高,中位愈合时间为180 d[95%置信区间(169.5,190.5)d]。性别、房颤类型对IASD愈合率影响无明显统计学意义(P>0.05),年龄>70岁是影响IASD愈合的因素(P<0.05)。随访1年后未愈合组(n=18)与愈合组(n=63)相比,右心大小及收缩舒张功能差异无明显统计学意义(P>0.05),而左心室大小差异有统计学意义(P<0.05),各随访点之间无明显差异;时间因素对左心房大小有明显影响,愈合组随访1年后左心房较前明显缩小。分组与随访时间交互作用无统计学意义(P>0.05)。结论经皮左心耳封堵术后IASD随着时间延长愈合率逐渐升高,较大的左心房、左心室及年龄>70岁可能与IASD愈合相关。

Objective To investigate the natural outcome of spontaneous closure of iatrogenic atrial septal defect(IASD)in patients with atrial fibrillation after transseptal catheterization and the influencing factors affecting its healing.Methods A total of 122 patients who underwent percutaneous left atrial appendage occlusion in West China Hospital,Sichuan University from September 2014 to February 2018 were selected for observation and follow-up.General information of the patients was collected.Each patient underwent transthoracic echocardiography and transesophageal echocardiography before the surgery or 45 days,3 months,6 months and 1 year after the surgery,observing the atrioventricular size,cardiac function and atrial septal defect size.The natural outcome of IASD and influencing factors and prognosis of IASD were analyzed.Results The healing rate increased gradually with the follow-up time;the median healing time was 180 days[95%confidence interval(169.5,190.5)days].The difference in the effect on IASD healing rate between the gender and atrial fibrillation type was not significant(P>0.05);being older than 70 years old was the influence factor for the IASD healing rate(P<0.05).There was no statistically difference in right heart size and systolic and diastolic function between the unhealed group(n=18)and the healed group(n=63)after a 1-year follow-up(P>0.05),but the left ventricular size was bigger in the unhealed group than that in the healed group(P<0.05).The follow-up time points had a significant effect on the size of the left atrium,and the left atrium in the healing group after 1 year follow-up was significantly smaller than before.There was no significant difference among the different follow-up time points and no interaction between grouping and follow-up time(P>0.05).Conclusions With the extension of follow-up time,the healing rate increases gradually.Larger left atrium and ventricular size and the age over 70 may be related to the healing of IASD.