主动脉根部缺如的房间隔缺损经导管介入治疗疗效分析

Transcatheter closure of atrial septal defect with complete aortic rim deficiency

目的探讨主动脉根部缺如的继发性房间隔缺损(atrial septal defect,ASD)患者介入治疗的安全性及有效性。方法回顾性选择2018年1月至2022年6月于复旦大学附属中山医院心血管内科接受诊治的402例ASD患者,所有患者均接受单一封堵器介入治疗,且接受6个月及1年随访。将其分为主动脉根部缺如组和正常组,比较两组患者临床特征、介入治疗情况、并发症。比较患者治疗前后超声心动图改善情况。结果相比边缘正常组(n=274),主动脉根部缺如组(n=128)使用的封堵器更大[(26.4±6.9)mmvs(23.4±7.7)mm,P<0.001]。两组患者术后均未出现严重手术并发症,术后右心重构明显改善,表现为肺动脉压力下降、右心房及右心室直径缩小、三尖瓣反流程度下降(P<0.001),左室射血分数无明显变化。结论介入治疗能改善主动脉根部缺如ASD的患者右心重构及功能。

Objective To investigate the safety and efficacy of interventional therapy in patients with secondary atrial septal defect(ASD)with complete aortic rim deficiency.Methods 402 patients with ASD who underwent transcatheter closure and followed up in outpatient at both 6-month and 1-year in the Department of Cardiology,Zhongshan Hospital,Fudan University from January 2018 to June 2020 were enrolled.They were divided into complete aortic rim deficiency group and normal aortic rim group.The clinical features,interventional parameters,and complications were compared between the two groups.Echocardiographic were used to evaluate the outcome.Results The occluder size was larger in the aortic rim deficiency group([26.4±6.9]mm,n=128)than that in normal aortic rim group([23.4±7.7]mm,P<0.001;n=274).Both groups exhibited no major postoperative complications,and significant improvements were observed in right heart remodeling following the operation,including pulmonary artery pressure decreasing,the diameters of the right atrium and right ventricle reducing,and the degree of tricuspid regurgitation reducing(P<0.001).There was no significant change in left ventricular ejection fraction in all patients.Conclusion Transcatheter closure of ASD with complete aortic rim deficiency is safe and feasible.