张端珍, 朱鲜阳, 仇俊玲, 崔春生, 盛晓棠. 大型动脉导管未闭封堵术后左心室功能变化[J]. 心脏杂志, 2015, 27(2): 210-212,215. DOI: 10.13191/j.chj.2015.0061
    引用本文: 张端珍, 朱鲜阳, 仇俊玲, 崔春生, 盛晓棠. 大型动脉导管未闭封堵术后左心室功能变化[J]. 心脏杂志, 2015, 27(2): 210-212,215. DOI: 10.13191/j.chj.2015.0061
    ZHANG Duan-zhen, ZHU Xian-yang, CHOU Jun-ling, CUI Chun-sheng, SHENG Xiao-tang. Changes of left ventricular size and function in patients undergoing percu-taneous closure of patent ductus arteriosus[J]. Chinese Heart Journal, 2015, 27(2): 210-212,215. DOI: 10.13191/j.chj.2015.0061
    Citation: ZHANG Duan-zhen, ZHU Xian-yang, CHOU Jun-ling, CUI Chun-sheng, SHENG Xiao-tang. Changes of left ventricular size and function in patients undergoing percu-taneous closure of patent ductus arteriosus[J]. Chinese Heart Journal, 2015, 27(2): 210-212,215. DOI: 10.13191/j.chj.2015.0061

    大型动脉导管未闭封堵术后左心室功能变化

    Changes of left ventricular size and function in patients undergoing percu-taneous closure of patent ductus arteriosus

    • 摘要: 目的:探讨存在左心室扩大的动脉导管未闭(patent ductus arteriosus,PDA)患者封堵术后左心室(left ventricular,LV)大小和功能变化规律。方法:以伴左心室扩大的青少年和成人PDA患者为研究对象,成功封堵PDA后定期随访LV大小和功能。术后24 h LV内径恢复正常者随访6个月;术后24 h未恢复正常者,随访至LV内径恢复正常。结果:共纳入患者391例,男63例,年龄(35±16)岁,PDA肺动脉端直径(7±2)mm。失访36(9.2%)例。封堵术后次日左心室大小和射血分数(LVEF)均明显减小(P<0.05)。术后次日,1,3,6和12个月LV大小恢复正常者分别为140(35.8%)例,108(30.4%)例,38(10.7%)例,23(6.5%)例和11(3.1%)例。12个月时LV内径未恢复正常35例(9.9%),其中7例于术后1.5~4年恢复正常,28例随访1~4.5年,LV大小仍未恢复正常。术后次日LV内径恢复正常和12个月仍未恢复正常患者,LVEF均于术后半年恢复至术前水平。结论:对于伴有LV增大的PDA患者,封堵术可致LVEF下降,术后需6个月方缓慢恢复,部分患者封堵术后需数年LV方能恢复正常大小。

       

      Abstract: AIM: To investigate the changes of left ventricular( LV) size and function after transcatheter closure of patent ductus arteriosus( PDA) in patients with enlarged LV. METHODS: Patients aged≥12 years with isolated PDA and enlarged LV and undergoing successful transcatheter device closure between January 2004 and December 2012 were recruited and followed up by transthoracic echocardiogram.Patients with normal LV on the day following the procedure were followed-up for 6 months and those with enlarged LV were followed-up until the size was restored to normal. RESULTS: A total of 391 patients( 63 males) aged 12-75( 35 ± 16) years were included in the study. The diameter of the PDA at the pulmonary artery end was( 7 ± 2) mm. Both LV size and ejection fraction( LVEF) decreased 24 h after the procedure( P < 0. 05). Thirty-six( 9. 2%) patients were lost to follow-up. A normal-sized LV was observed in 140( 35. 8%) patients on the day following the procedure,including 108 patients( 30. 4%)at 1 month,38( 10. 7%) at 3 months,23( 6. 5%) at 6 months and 11( 3. 1%) at 12 months. An enlarged LV was still present in 35( 9. 9%) patients at 12 months after procedure. CONCLUSION: In patients with PDA and enlarged LV,device closure of PDA significantly decreases LV size and leads to marked deterioration of LV functions. Approximately 6 months are necessary for LVEF to restore to baseline level after PDA closure. Interruption of the left-to-right shunt does not indicate immediate normalization of size of the LV. In some patients,it takes 1 or more years for the LV to restore to normal size after this procedure.

       

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