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中华心脏与心律电子杂志

中华心脏与心律电子杂志 ›› 2022, Vol. 10 ›› Issue (02) : 88 -92. doi: 10.3877/cma.j.issn.2095-6568.2022.02.004

所属专题： 总编推荐；

结构性心脏病

老年房间隔缺损介入封堵的单中心疗效分析
沈卉1, 孙劲禹1, 钟旻珊1, 史倞1, 孙伟1,†()   
  1. 1. 210029　南京，南京医科大学第一附属医院（江苏省人民医院）心血管内科
  • 收稿日期:2022-05-05 出版日期:2022-06-25
  • 通信作者: 孙伟

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

Hui Shen1, Jingyu Sun1, Minshan Zhong1, Jing Shi1, Wei Sun1,†()   

  1. 1. Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China
  • Received:2022-05-05 Published:2022-06-25
  • Corresponding author: Wei Sun
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沈卉, 孙劲禹, 钟旻珊, 史倞, 孙伟. 老年房间隔缺损介入封堵的单中心疗效分析[J]. 中华心脏与心律电子杂志, 2022, 10(02): 88-92.

Hui Shen, Jingyu Sun, Minshan Zhong, Jing Shi, Wei Sun. The efficacy of transcatheter device closure of atrial septal defect in elderly patients[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(02): 88-92.

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。

关键词: 房间隔缺损, 介入封堵治疗, 运动耐量, 心脏逆重构
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.

Key words: Atrial septal defect, Transcatheter device closure, Exercise capacity, Cardiac reverse remodeling
表1 51例老年房间隔缺损患者基线特征
项目 数值
年龄（岁，
x¯±s
）		 65.75±4.04
男性［例（%）］ 19（37.3）
体重指数（kg/m2，
x¯±s
）		 23.50±2.62
合并症［例（%）］

心房颤动或心房扑动

 15（29.4）

冠心病

 10（19.6）

高血压

 25（49.0）

糖尿病

 8（15.7）

脑卒中

 8（15.7）
心导管检查

肺动脉压（mmHg，

x¯±s
）

 23.51±5.40

Qp/Qs（

x¯±s
）

 2.39±1.07

肺小动脉阻力（Wood，

x¯±s
）

 2.61±0.95

肺动脉高压［例（%）］

 18（35.3）
房间隔缺损大小（mm，
x¯±s
）		 18.25±5.97
实验室检查

NT-proBNP［pg/ml，M（IQR）］

 315.3（84.0，892.0）

血红蛋白（g/L，

x¯±s
）

 136.80±13.96

血清肌酐（μmol/L，

x¯±s
）

 66.47±13.69
表2 28例老年房间隔缺损患者术前、术后第2天及术后1个月时的6 min步行距离构成比比较
时间

轻度异常或正常

［例（%）］

中重度异常

［例（%）］

 χ2值 P值
术前 10（35.7） 18（64.3） 7.528 0.023
术后第2天 13（46.4） 15（53.6）
术后1个月 20（71.4） 8（28.6）ab
表3 51例老年房间隔缺损患者术前与术后第2天超声心动图参数比较（
xˉ±s
）
项目 术前 术后 差值（95%CI） P值
右心房内径（mm） 41.24±4.56 39.25±4.83 1.98（0.98，2.98） ＜0.001
右心室内径（mm） 40.92±3.97 38.55±4.23 2.37（1.40，3.35） ＜0.001
左心房内径（mm） 38.47±5.39 37.00±4.02 1.47（0.42，2.53） 0.007
左心室收缩末期内径（mm） 29.29±3.04 30.08±3.94 -0.78（-1.77，0.21） 0.118
左心室舒张末期内径（mm） 44.49±3.82 45.53±4.18 -1.04（-2.12，0.04） 0.058
估测PASP（mmHg） 39.82±8.31 32.76±6.34 7.06（4.68，9.44） ＜0.001
左心室射血分数（%） 63.23±3.46 63.71±3.38 -0.48（-1.30，0.34） 0.249
E/e’ 8.48±1.59 9.68±3.02 -1.21（-2.21，-0.20） 0.020
E/A 0.78±0.25 0.85±0.24 -0.06（-0.15，0.02） 0.140
表4 28例老年ASD患者术前与术后1个月超声心动图参数比较
项目 术前 术后1个月 差值（95%CI） P值
右心房内径（mm） 41.46±3.95 38.14±5.59 3.32（1.49，5.15） 0.001
右心室内径（mm） 41.39±3.53 36.71±4.38 4.68（3.00，6.35） ＜0.001
左心房内径（mm） 38.04±5.27 39.25±5.50 -1.21（-2.52，0.09） 0.066
左心室收缩末期内径（mm） 29.29±3.43 30.89±3.94 -1.60（-2.75，-0.47） 0.007
左心室舒张末期内径（mm） 44.43±4.09 46.57±4.06 -2.14（-3.69，-0.60） 0.008
估计PASP（mmHg） 40.21±7.99 33.79±7.04 6.43（3.53，9.33） ＜0.001
左心室射血分数（%） 63.25±4.13 62.71±4.80 0.54（-0.94，2.02） 0.462
E/e’ 8.65±1.51 11.74±3.90 -3.09（-4.97，-1.20） 0.003
E/A 0.83±0.23 1.06±0.42 -0.23（-0.42，-0.03） 0.027
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