标题：超声心动图评价房间隔缺损合并肺动脉高压者封堵术后心脏形态学变化

      作者：张 洁 1，杨炳昂 1，陈关良 2，钟文津 1，唐海霞 1，莫泽来 1
    (海南省人民医院超声科 1、心内科 2，海南 海口 570311)

      卷次： 2014年25卷17期

      【摘要】 目的 探讨超声心动图评价房间隔缺损(ASD)，尤其是合并肺动脉高压者介入封堵术后心脏结构
及功能改变的价值。方法 经超声心动图确诊为ASD并成功施行封堵术的患者 109例，肺动脉压力正常者 55
例，轻度肺动脉高压者(PASP，35~50 mmHg) 25例，中度肺动脉高压者(PASP，50~70 mmHg) 17例，重度肺动脉高
压(PASP>70 mmHg)者12例。分别于封堵术前3 d，术后3 d、1个月、3个月、6个月行超声心动图检查，测量心脏结
构及心功能。结果 肺动脉压力正常者及轻度肺动脉高压者，与术前相比，术后3 d右心房、右心室和肺动脉内
径减小(P<0.05)，肺动脉瓣口血流速度降低，左心室内径增大，左心房和主动脉内径在术后1个月增大(P<0.05)，在
后期随访中上述变化逐渐趋于稳定；中度肺动脉高压者与术前相比，右心房和右心室内径在术后3个月时变化差
异有统计学意义(P<0.05)，左心室和左心房分别在术后3个月、6个月时变化差异有统计学意义(P<0.05)；重度肺
动脉高压者与术前相比，左心房和左心室内径在6个月时变化差异有统计学意义(P<0.05)，但右心房、右心室、主
动脉及肺动脉内径变化差异均无统计学意义(P>0.05)。结论 中重度肺动脉高压ASD患者，通过封堵术可增加
患者手术机会，但其心脏结构恢复时间长且效果差。

      【关键词】 房间隔缺损；超声心动图；封堵术；肺动脉高压

      【中图分类号】 R541.1 【文献标识码】 A 【文章编号】 1003—6350（2014）17—2540—04


Changes in cardiac morphology of patients with atrial septal defect combing pulmonary hypertension underwent
transcatheter closure evaluated by echocardiography.
ZHANG Jie 1, YANG Bing-ang 1, CHEN Guan-liang 2, ZHONG
Wen-jin 1, TANG Hai-xia 1, MO Ze-lai 1. Department of Ultrasonography 1, Department of Cardiology 2, People's Hospital
of Hainan Province, Haikou 570311, Hainan, CHINA

【Abstract】 Objective To explore the clinical value of echocardiography in evaluating the changes in cardiac
morphology and function of patients with atrial septal defect underwent transcatheter closure, especially when com-
bined with pulmonary hypertension. Methods A total of 109 patients with ASD diagnosed by echocardiography who
have had the operation of transcather closure were enrolled. They were divided into normal pulmonary artery pressure
group (n=55), mild pulmonary hypertension group (PASP, 35~50 mmHg, n=25), moderate pulmonary hypertension
group (PASP, 50~70 mmHg, n=17) and severe pulmonary hypertension group (PASP>70 mmHg, n=12). The echocar-
diographic examination was carried out 3 days before the operation, 3 days after the operation, 1 month, 3 months and
6 months after the operation respectively, to evaluate the morphology and function of heart. Results In normal pulmo-
nary artery pressure group and mild pulmonary hypertension group, the diameters of right atrium, right ventricle, pulmo-
nary artery and the blood flow of pulmonary valve decreased 3 days after the operation (P<0.05). The diameter of left
ventricle increased 3 days after the operation; while the diameters of left atrium and aorta increased 1 month after the op-
eration (P<0.05). These changes remained relatively stable in late follow-ups. In moderate pulmonary hypertension
group, the diameters of right atrium, right ventricle decreased 3 months after the operation (P<0.05). The diameter of
left ventricular increased 3 months after the operation (P<0.05) while the diameter of left atrium increased 6 months af-
·论 著·doi:10.3969/j.issn.1003-6350.2014.17.0993