Transcatheter closure of atrial septal defect with functional tricuspid regurgitation in adults
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摘要:
目的 探讨经导管封堵成人房间隔缺损（atrial septal defect, ASD）后能否改善其合并的功能性三尖瓣返流（tricuspid regurgitation, TR）。 方法 连续纳入自2019年1月1日～2020年12月31日在空军军医大学西京医院心血管内科经导管封堵的ASD合并功能性TR患者，根据术前超声心动图评估TR严重程度并进行分级，术后6个月进行超声心动图随访，评估功能性TR的改善程度。 结果 与合并轻度TR组相比，合并中/重度TR组患者年龄较大（P<0.01），ASD直径较大，RV直径较大（均P<0.05），与合并中度TR组相比，合并重度TR组患者年龄较大（P<0.01），RV直径较大（P<0.05）。封堵前，11例患者合并重度TR，18例患者合并中度TR， 71例患者合并轻度TR；封堵术后6个月，10例患者（91%）由重度TR降至轻度，12例患者（67%）由中度TR降至轻度。所有患者中无轻度TR患者的返流量增加至中度或重度。单变量分析显示，持续性TR与肺动脉直径、右房直径、右室直径、左房直径、左室直径及ASD大小相关。经过多变量分析，以上因素均非独立的预测因素。根据封堵器类型分层进行分析发现国产封堵器与进口封堵器在改善功能性TR疗效方面无统计学差异。 结论 经导管封堵ASD能够改善ASD患者合并的功能性TR。 Abstract:AIM To investigate whether transcatheter closure of atrial septal defect (ASD) can improve functional tricuspid regurgitation (TR). METHODS We prospectively enrolled ASD patients with functional TR who underwent transcatheter closure in Xijing Hospital, Air Force Medical University from January 1, 2019 to December 31, 2020. All patients took echocardiography before the transcatheter closure. Functional TR was classified to severe, moderate and mild according to the echocardiographic assessment. Echocardiography follow-up was performed at 6 months after the procedure to evaluate the improvement of TR. RESULTS Compared with the mild TR group, the patients in the moderate/severe TR group were older (P<0.01), the ASD diameter was larger, and the RV diameter was larger (all P<0.05). Compared with the moderate TR group, the patients in the severe TR group were older (P<0.01), and the RV diameter was larger (P<0.05). Before occlusion, 11 patients had severe TR, 18 patients had moderate TR, and 71 patients had mild TR; Six months after occlusion, 10 patients (91%) decreased from severe TR to mild TR, and 12 patients (67%) decreased from moderate TR to mild TR. None of the patients with mild TR had increased reflux to moderate or severe. Univariate analysis showed that persistent TR was associated with, pulmonary artery diameter, right atrial diameter, right ventricular diameter, left atrial diameter, left ventricular diameter and ASD size. Through multivariate analysis, the above factors are not independent predictors. According to the classification of occluder types, it was found that there was no statistical difference between domestic occluder and imported occluder in improving the efficacy of functional TR. CONCLUSION In this single center study, transcatheter closure of ASD improves the functional TR of ASD patients. -
Key words:
- atrial septal defect /
- tricuspid regurgitation /
- transcatheter closure
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表 1 基线临床特征
项目 轻度TR
(n=71)中度TR
（n=18）重度TR
（n=11）年龄（岁） 34±10 36±6 b 40±7 bd 女性 48（67） 15（83） 9（81） ASD直径（mm） 15±6 16±6 a 16±6 a 主动脉直径（mm） 28±4 26±5 26±6 肺动脉直径（mm） 25±4 24±5 24±5 LA直径（mm） 34±4 33±6 33±6 RA直径（mm） 42±6 42±8 42±8 RV直径（mm） 33±7 34±7 a 36±7 ac LV舒张末直径（mm） 40±4 41±6 41±6 LV收缩末直径（mm） 27±4 28±5 29±5 表中计数资料均为[例数（%）]，与合并轻度TR组相比，aP<0.05，bP<0.01；与合并中度TR组相比，cP<0.05，dP<0.01 
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表 2 ASD封堵术后TR及心脏结构变化
（n=29， $ \bar x $ ± s)项目 术前 术后6月 肺动脉直径（mm） 24±4 22±4 a LA直径（mm） 34±4 330±5 a RA直径（mm） 40±15 34±5 b RV直径（mm） 30±8 24±4 b LV舒张末期直径（mm） 44±4 44±5 LV收缩末期直径（mm） 30±4 30±4 与术前比较，aP<0.05，bP<0.01
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表 3 TR的影响因素分析
项目 单变量分析 多变量分析 F值 P值 优势比（95% 置信区间） P值 年龄（岁） 3.89 0.24 0.96（0.88-1.03） 0.28 ASD直径(mm） 8.59 <0.01 0.96（0.76-1.21） 0.72 肺动脉直径（mm） 6.73 <0.01 0.68（0.83-1.06） 0.61 LA直径（mm） 7.83 <0.01 0.95（0.72-1.24） 0.71 RA直径（mm） 7.81 <0.01 0.85（0.68-1.06） 0.16 RV直径（mm） 42.68 <0.01 0.87（0.71-1.07） 0.21 LV舒张末期直径（mm） 4.72 0.03 1.20（0.56-1.82） 0.59 LV收缩末期直径（mm） 5.87 0.01 0.96（0.62-2.31） 0.95
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表 4 国产封堵器与进口封堵器比较
（ $ \bar x $ ± s)项目 国产（n=54） 进口（n=46） TR人数 4 3 LA直径（mm） 34±4 34±4 RA直径（mm） 35±5 34±7 RV直径（mm） 25±8 24±7 LV舒张末期直径（mm） 44±4 45±5 LV收缩末期直径（mm） 31±4 31±4 住院时间（d） 4±2 4±2
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[1] Iosifescu AG, Popescu A, Iosifescu TA, et al. Surgery for functional tricuspid regurgitation in adult atrial septal defect-an increasing subject in a decreasing matter[J]. Braz J Cardiovasc Surg, 2022, 37(3): 306 – 314. doi: 10.21470/1678-9741-2020-0503 [2] Fang F, Wang J, Yip GW, et al. Predictors of mid-term functional tricuspid regurgitation after device closure of atrial septal defect in adults: impact of pre-operative tricuspid valve remodeling[J]. Int J Cardiol, 2015, 187: 447 – 452. doi: 10.1016/j.ijcard.2015.03.332 [3] Jategaonkar SR, Scholtz W, Horstkotte D, et al. Interventional closure of atrial septal defects in adult patients with Ebstein's anomaly[J]. Congenit Heart Dis, 2011, 6(4): 374 – 381. doi: 10.1111/j.1747-0803.2011.00493.x [4] Nassif M, van der Kley F, Abdelghani M, et al. Predictors of residual tricuspid regurgitation after percutaneous closure of atrial septal defect[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(2): 225 – 232. doi: 10.1093/ehjci/jey080 [5] Giamberti A, Chessa M, Ballotta A, et al. Functional tricuspid valve regurgitation in adults with congenital heart disease: an emerging problem[J]. J Heart Valve Dis, 2011, 20(5): 565 – 570. [6] Nakagawa K, Akagi T, Taniguchi M, et al. Transcatheter closure of atrial septal defect in a geriatric population[J]. Catheter Cardiovasc Interv, 2012, 80(1): 84 – 90. doi: 10.1002/ccd.23457 [7] Thapa R, Dawn B, Nath J. Tricuspid regurgitation: pathophysiology and management[J]. Curr Cardiol Rep, 2012, 14(2): 190 – 199. doi: 10.1007/s11886-012-0245-2 [8] Chen L, Shen J, Shan X, et al. Improvement of tricuspid regurgitation after transcatheter ASD closure in older patients[J]. Herz, 2018, 43(6): 529 – 534. doi: 10.1007/s00059-017-4594-x [9] Bae YH, Jang WS, Kim JY, et al. Time course of ventricular remodeling after atrial septal defect closure in adult patients[J]. J Chest Surg, 2021, 54(1): 45 – 52. doi: 10.5090/kjtcs.20.098 [10] Bach Y, Abrahamyan L, Lee DS, et al. Long-term outcomes of adults with tricuspid regurgitation following transcatheter atrial septal defect closure[J]. Can J Cardiol, 2022, 38(3): 330 – 337. doi: 10.1016/j.cjca.2021.12.012 [11] Attenhofer Jost CH, Connolly HM, Scott CG, et al. Increased risk of possible paradoxical embolic events in adults with ebstein anomaly and severe tricuspid regurgitation[J]. Congenit Heart Dis, 2014, 9(1): 30 – 37. doi: 10.1111/chd.12068 [12] Guler S, Reyhancan A, Kubat E, et al. Impact of additional annuloplasty on tricuspid valve and cardiac functions after atrial septal defect closure in adults[J]. J Card Surg, 2020, 35(11): 2895 – 2901. doi: 10.1111/jocs.14905 [13] Abohamar MD, Ashmawy MM, Kasem HK, et al. Original article-predictors of persistent functional tricuspid regurgitation after transcatheter closure of atrial septal defect and its relationship to tricuspid valve remodeling[J]. J Saudi Heart Assoc, 2021, 33(1): 53 – 60. doi: 10.37616/2212-5043.1241 [14] Takaya Y, Akagi T, Kijima Y, et al. Functional tricuspid regurgitation after transcatheter closure of atrial septal defect in adult patients: long-term follow-up[J]. JACC Cardiovasc Interv, 2017, 10(21): 2211 – 2218. doi: 10.1016/j.jcin.2017.06.022 [15] Abdullah HAM, Alsalkhi HA, Khalid KA. Transcatheter closure of sinus venosus atrial septal defect with anomalous pulmonary venous drainage: innovative technique with long-term follow-up[J]. Catheter Cardiovasc Interv, 2020, 95(4): 743 – 747. doi: 10.1002/ccd.28364 -
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