我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

大型动脉导管未闭封堵术后左心室功能变化

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第2期
页码:
210-212215
栏目:
临床研究
出版日期:
2014-10-25

文章信息/Info

Title:
Changes of left ventricular size and function in patients undergoing percutaneous closure of patent ductus arteriosus
作者:
张端珍; 朱鲜阳; 仇俊玲; 崔春生; 盛晓棠
(沈阳军区总医院先心病内科，辽宁 沈阳 110016)
Author(s):
ZHANG Duan-zhen;  ZHU Xian-yang;  QIU Jun-ling;  CUI Chun-sheng;  SHENG Xiao-tang
(Department of Congenital Heart Disease, Shenyang General Hospital, Shenyang Military Area Command, Shenyang 110016, Liaoning, China)
关键词:
心脏病; 先天性; 动脉导管未闭; 介入治疗; 左心室
Keywords:
congenital heart disease;  patent ductus arteriosus;  interventional therapy;  left ventricle
分类号:
R541.1
DOI:
-
文献标识码:
A
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24h 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.

参考文献/References

[1]Schneider DJ,Moore JW.Patent ductus arteriosus[J].Circ,2006,144(17):1873-1882.
[2]Galal MO,Amin M,Hussein A,et al.Left ventricular dysfunction after closure of large patent ductus arteriosus[J].Asian Cardiovasc Thorac Ann,2005,13(1):24-29.
[3]Eerola A,Jokinen E,Boldt T,et al.The influence of percutaneous closure of patent ductus arteriosus on left ventricular size and function:a prospective study using two- and three-dimensional echocardiography and measurements of serum natriuretic peptides[J].J Am Coll Cardiol,2006,47(5):1060-1066.
[4]Galal MO,Arfi MA,Nicole S,et al.Left ventricular systolic dysfunction after transcatheter closure of a large patent ductus arteriosus[J].J Coll Physicians Surg Pak,2005,15(11):723-725.
[5]Jeong YH,Yun TJ,Song JM,et al.Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults:device and surgical closure[J].Am Heart J,2007,154(3):436-440.
[6]郑昭芬,蒲晓群,杨天伦,等.国产蘑菇伞封堵治疗动脉导管未闭对左心室功能影响[J].医学临床研究,2006,23(12):1951-1953.
[7]代政学,张玉顺,李 寰,等.成人动脉导管未闭Amplatzer封堵器封堵术后左心功能的变化[J].第四军医大学学报,2002,23(14):1321-1322.
[8]周爱卿,蒋世良.先天性心脏病经导管介入治疗指南[J].中华儿科杂志,2004,42(3):76-81.
[9] Mcmanus DD,Shah SJ,Fabi MR,et al.Prognostic value of left ventricular end-systolic volume index as a predictor of heart failure hospitalization in stable coronary artery disease: data from the Heart and Soul Study[J].J Am Soc Echocardiogr,2009,22(2):190-197.
[10]Coletta C,Galati A,Ricci R,et al.Prognostic value of left ventricular volume response during dobutamine stress echocardiography[J].Eur Heart J,1997,18(10):1599-1605.

备注/Memo

备注/Memo:
收稿日期: 2014-05-27.
通讯作者：朱鲜阳，主任医师，主要从事结构性心脏病影像诊断和介入治疗研究Email：xyangz 2011@163.com
作者简介：张端珍，副主任医师,博士 Email：meichengzhang123@163.com
更新日期/Last Update: 2014-11-18