不同年龄段继发孔型房间隔缺损患者封堵术后心脏重构的临床研究

Clinical study of cardiac remodeling after transcatheter closure of ostium secundum atrial septal defect in diff erent age groups

目的探讨不同年龄段房间隔缺损患者经皮封堵术后心脏重构的变化过程。方法收集2015年8月至2019年10月在北部战区总医院先心病内科成功接受经皮房间隔缺损封堵术治疗的患者211例,按患者年龄分为3组:A组(年龄<18岁,50例)、B组(18~40岁,79例)、C组(年龄>40岁,82例)。应用经胸超声心动图测量指标:右心房内径、右心室舒张末期内径、左心房内径、左心室舒张末期内径,观察患者术后第2天、术后1个月、术后3个月、术后6个月较术前的变化情况。结果各年龄组患者术后右心房内径(F=50.48,P<0.05)、右心室内径均减小(F=60.00,P<0.05),左心室舒张末期内径增大(F=15.72,P<0.05),左心房内径无明显变化(F=1.59,P>0.05)。各年龄组患者术后第2天即可出现显著的心脏重构,此过程于术后1个月变化趋于平缓。A组患者术后第2天右心房内径即明显减小[(32.78±6.68)mm比(29.36±5.54)mm,P<0.05],这种变化趋势持续到术后1个月,仍可观察到上述指标的进一步减小,与术后第2天相比差异有统计学意义[(29.36±5.54)mm比(27.06±5.60)mm,P<0.05]。术后3个月时右心房内径仍有减小,但差异较术后1个月无统计学意义[(27.06±5.60)mm比(26.89±5.13)mm,P>0.05],此后右心房内径变化不明显。右心室内径与右心房内径变化过程相似。而左心室舒张末期内径主要表现为逐渐增大,术后6个月时左心室舒张末期内径已经由(35.32±5.56)mm增到(37.91±5.44)mm。B组、C组术后各心腔内径变化趋势与A组类似,均在术后早期即可出现明显心脏重构,此过程持续约1个月后逐渐趋于平缓。结论各年龄段的房间隔缺损患者封堵术后早期均可发生明显心脏重构,此过程随时间延长趋于平稳。不同年龄的房间隔缺损患者术后右心室重构能力不同,随年龄增加降低。因此符合封堵术适应证的患者,均应尽早行手术治疗。

Objective To observe the changes of cardiac remodeling after transcatheter closure of atrial septal defect in patients of diff erent age groups.Methods From August 2015 to October 2019,211 patients in our hospital underwent percutaneous transcatheter closure of atrial septal defect were enrolled into this study.According to the age,they were divided into 3 groups:group A(age<18 years,n=50),group B(age 18-40 years,n=79),group C(age>40 years old,n=82).The diameters of right atrial,right ventricular end diastolic,left atrial,and left ventricular end diastolic were measured by transthoracic echocardiography.The measurements were observed at 2 days,1 month,3 months and 6 months after the procedure compared with the preoperative changes.Results The diameters of right atrial(F=50.48,P<0.05)and the right ventricular decreased(F=60.00,P<0.05),the left ventricular end diastolic diameter increased(F=15.72,P<0.05),and there was no signifi cant change in the left atrial diameter(F=1.59,P>0.05)in all patients.All patients had signifi cant cardiac remodeling at 2 days postoperatively which had changed gradually in 1 month.The diameters of right atrium and right ventricular decreased immediately postoperatively,the trend remained for 1 month,and it was not obvious at 3 months.However,the diameter of left ventricular end diastolic increased gradually.The diameter of left atrial did not change signifi cantly during the 6 months follow-up.There was no signifi cant diff erence in the diameter of the right atrium and left ventricle among the three groups.The change of the right ventricular diameter in group C in variation was smaller than that in group A and group B.The change of the size of the right ventricle in variation decreased with aging,and the heart remodeling ability decreased in the patients older than 40 years.Conclusions All patients had signifi cant cardiac remodeling at early stage after the procedure,and this process tended to be stable over time.The ability of right ventricular remodeling in diff erent age groups decreased with aging.Therefore,patients with indications of occlusion should be transcatheter closure of atrial septal defect as early as possible.