老年房间隔缺损介入封堵的单中心疗效分析

The efficacy of transcatheter device closure of atrial septal defect in elderly patients

目的:探讨介入封堵治疗老年房间隔缺损(ASD)患者的安全性及有效性。方法:回顾性收集2018年3月至2022年2月南京医科大学第一附属医院心血管内科收治的60岁以上并接受单一封堵器介入治疗的继发孔型ASD患者的临床资料。比较其术前、术后第2天、术后1个月的6 min步行距离(6MWD)及超声心动图结果。结果:共收集51例患者,年龄(65.75±4.04)岁,其中男19例。所有患者术后均未出现重大手术并发症。与术前相比,术后第2天及1个月时右心房内径[(41.24±4.56)mm对(39.25±4.83)mm,P<0.001;(41.46±3.95)mm对(38.14±5.59)mm,P=0.001]、右心室内径[(40.92±3.97)mm对(38.55±4.23)mm,P<0.001;(41.39±3.53)mm对(36.71±4.38)mm,P<0.001)]、估测肺动脉收缩压[(39.82±8.31)mmHg对(32.76±6.34)mmHg,P<0.001;(40.21±7.99)mmHg对(33.79±7.04)mmHg,P<0.001]均显著降低;术后1个月舒张早期二尖瓣血流峰值速度与舒张早期二尖瓣瓣环峰值速度比值(E/e')(8.65±1.51对11.74±3.90,P=0.003)及左心室收缩期及舒张期内径显著升高[(29.29±3.43)mm对(30.89±3.94)mm,P=0.007;(44.43±4.09)mm对(46.57±4.06)mm,P=0.008];但左心室射血分数无明显变化;术后1个月时6MWD显著改善(中重度异常患者构成比:64.3%对28.6%,P=0.007)。结论:介入封堵治疗老年房间隔缺损具有良好的安全性,能够显著改善患者的运动耐量,改善右心功能。

Objective To investigate the safety and efficacy of transcatheter device closure of atrial septal defect(ASD)in elderly patients.Methods Between March 2018 and February 2022,patients with secundum ASD who underwent transcatheter device closure in Department of Cardiology,The First Affiliated Hospital with Nanjing Medical University were included.Echocardiographic data and 6 minutes'walk distance(6MWD)before and after the procedure were retrospectively collected.Results A total of 51 patients were enrolled.The age was(65.75±4.04)years old.And 19 of them were male.There were no major complications occurred during perioperative period.Right atrial diameter(RAD)[(41.24±4.56)mm vs.(39.25±4.83)mm,P<0.001;(41.46±3.95)mm vs.(38.14±5.59)mm,P=0.001],right ventricular diameter(RVD)[(40.92±3.97)mm vs.(38.55±4.23)mm,P<0.001;(41.39±3.53)mm vs.(36.71±4.38)mm,P<0.001)]and estimated pulmonary artery systolic pressure(PASP)[(39.82±8.31)mmHg vs.(32.76±6.34)mmHg,P<0.001;(40.21±7.99)mmHg vs.(33.79±7.04)mmHg,P<0.001]were significantly decreased at the second day and 1 month after procedure.The ratio of early diastolic transmitral flow velocity(E)to mitral annular motion velocity(e',E/e'ratio)(8.65±1.51 vs.11.74±3.90,P=0.003)and left ventricular end-systolic and diastolic diameter[(29.29±3.43)mm vs.(30.89±3.94)mm,P=0.007;(44.43±4.09)mm vs.(46.57±4.06)mm,P=0.008]increased significantly at 1 month after procedure.Left ventricular ejection fraction(LVEF)did not differ significantly between baseline and after procedure.The result of 6MWD was significantly improved at 1 month after procedure(the proportion of moderate to severe abnormal was 64.3%vs.28.6%,P=0.007).Conclusion Transcatheter device closure in the elderly patients were of good safety and improved exercise capacity and right ventricular function.