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|本期目录/Table of Contents|

成人继发孔型房间隔缺损并发房颤患者三种治疗方法分析

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第3期
页码:
330-333
栏目:
临床研究
出版日期:
2014-03-20

文章信息/Info

Title:
Treatment strategies for secundum atrial septal defect with atrial fibrillation in adult patients
作者:
胡英锋
(武汉市亚洲心脏病医院心外科，湖北 武汉 430022)
Author(s):
HU Ying feng
(Cardiovascular Surgery, Wuhan Asia Heart Hospital, Wuhan 430022, Hubei, China)
关键词:
房间隔缺损; 心房颤动; 介入封堵术; 房间隔缺损修补术
Keywords:
secundum atrial septal defect;  atrial fibrillation;  interventional closure;  ASD repair operation
分类号:
R541.1；R541.71
DOI:
-
文献标识码:
A
摘要:
目的:介绍成人房间隔缺损（ASD）并发心房颤动（AF）患者的几种治疗方法，并分析其治疗效果。方法:回顾分析本院136例ASD并发有明显临床症状且药物治疗无效的AF病例，其中36例接受介入封堵+经导管射频消融术（导管射频消融组），84例体外循环下ASD补术+改良迷宫术（改良迷宫组），16例单纯介入封堵术（未行经导管射频消融术，单纯介入封堵组），术前，术后12月用心脏超声仪评价右心房、右室内径及肺动脉压力和心电图变化。结果:所有病例的术中、术后均未出现严重并发症，所有病例均无死亡，随访12个月，36例接受介入封堵+经导管射频消融术28例转复为窦性心律，8例仍为AF，后行二次射频消融术转为窦性心律，84例ASD补术+改良迷宫手术患者中有66例转复窦性，14例失败仍为AF，4例为交界性心律，单纯介入封堵组16例8例成功，8例术后仍为AF，与术前比较，各组心脏超声检查示右心房、右心室内径均较术前明显缩小，肺动脉压力明显下降（均P<0.05）。各组之间无显著差异。经导管射频消融组和改良迷宫手术组AF治愈率高（对比单纯介入组，均P<0.05），患者心慌不适更能得到改善，生活质量更高。结论:介入封堵及外科手术均能安全有效治疗ASD并发AF，每种方法各有利弊，可依据患者临床具体情况选择。
Abstract:
AIM:To introduce treatment strategies and analyze their therapeutic effect for atrial septal defect (ASD) with atrial fibrillation (AF) in adult patients. METHODS: Twenty-four patients with atrial septal defect with significant clinical symptoms and ineffective drug treatment were analyzed. In the radiofrequency catheter ablation (RFA) group there were four patients who underwent transcatheter closure of ASD and radiofrequency catheter ablation, in the RFA maze group there were 14 patients who underwent ASD repair operation and radiofrequency ablation modified maze procedure with cardiopulmonary bypass, and in the simple interventional closure group there were six cases who underwent only transcatheter closure of ASD and no radiofrequency catheter ablation. Preoperatively and 12 months postoperatively, electrocardiogram and echocardiogram were compared. RESULTS: No serious complications and operative death occurred in the 24 patients under study. In the radiofrequency catheter ablation group, three patients restored to sinus rhythm after a 12-month follow-up and one patient underwent radiofrequency ablation again before restoration to sinus rhythm. In the RFA maze group 11 patients restored to sinus rhythm after the same 12-month period, two patients remained in atrial fibrillation and one patient remained in junctional rhythm. The success rate of sinus rhythm was 50% in the simple interventional closure group. Compared with the preoperative measurements, echocardiography showed that right atrium and right ventricular diameter significantly reduced in each group (all P<0.05) and pulmonary artery pressure significantly decreased (all P<0.05), with no significant differences among the three groups. The success rates of sinus rhythm in both radiofrequency catheter ablation group and RFA maze group were higher than in the simple interventional closure group. CONCLUSION: Transcatheter closure and ASD repair surgery are effective and safe for treating secundum-type ASD. Radiofrequency catheter ablation and RFA maze procedure are effective in resolving AF for ASD patients with AF and strengthen heart function. Appropriate selection of the treatment strategy for ASD with AF is the key to surgical success.

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备注/Memo

备注/Memo:
收稿日期：2013-06-07.
作者简介：胡英锋，主治医师 Email：hyfbluehp@sohu.com
更新日期/Last Update: 2014-03-21