先天性心脏病经皮导管封堵术后心电及心室重构变化的研究
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摘要
目的观察先天性心脏病(先心病)患者经皮导管封堵术后心电及心室形态、功能的变化,探讨封堵术后近期心电及心室重构的影响。
方法成功施行经皮导管封堵术的先心病患者111例,其中ASD47例,VSD44例,PDA20例。通过TTE、ECG及动态心电图,观察先心病患者经导管封堵术前、术后心电参数、心室形态和功能超声指标。
结果1、经皮导管封堵术后心电变化:(1)与ASD封堵术前比较,术后3天、1个月、3个月及6个月的RBBB发生率明显减少(P均﹤0.05),但患者术后3天、1个月、3个月及6个月之间的RBBB发生率无明显差别(P均﹥0.05)。与ASD封堵术前比较,术后1个月、3个月及6个月的电轴右偏发生率明显减少(P均﹤0.01)。(2)与VSD封堵术前比较,术后3天的RBBB/LBBB发生率明显增多(P均﹤0.05),但患者术后3个月及6个月的RBBB/LBBB发生率又逐渐减少至正常(P均﹤0.05)。(3)与PDA封堵术前比较,患者术后3个月、6个月的LVH发生率均明显下降(P均﹤0.01),术后1个月、3个月、6个月的电轴左偏发生率均明显下降(P均﹤0.01)。2、经皮导管封堵术后动态心电图参数改变:(1)ASD封堵术后患者平均心率、室上性早搏、室性早搏及房性心律失常发生率与术前相比无明显差别(P均﹥0.05)。(2)VSD封堵术后患者平均心率、室上性早搏、室性早搏与术前相比无明显差别(P均﹥0.05),但术后2天内阵发性室性心动过速发生率明显多于术前(P均﹤0.01)。(3)PDA封堵术后患者平均心率、室上性早搏、室性早搏及房性心律失常发生率与术前相比无明显差别(P均﹥0.05)。3、经皮导管封堵术后心室形态及功能改变:(1)、与ASD封堵术前相比较,ASD患者术后1个月、3个月及6个月的LVED、LVEDD、LVSD及LVESD均明显增加(P均﹤0.05),RVED、RVOTD明显缩小(P均﹤0.01);但患者术后1个月、3个月及6个月之间LVED、LVEDD、LVSD、
Objectives To investigate the changes of electrophysiology and ventricular form, function after transcatheter device closure of ASD, VSD and PDA.And evaluate the effect on the electrophysiology and ventricular-remodeling after procedure in patients with congenital heart disease.
Methods 111 patients underwent procedure successfuly, 47 was ASD,44 was VSD and 20 was PDA. All patients were performed 12 lead- synchronous surface electrocardiogram, Ambulatory Holter monitoring and TTE study, analysised the parameters of electrocardic and the indexs of ventricular form and function pre- and after- procedure.
Results 1 The changes of electrophysiology after procedure. (1) In patients with ASD, compared with the pre-procedure, 3 days,1,3 and 6 months later, the incidence rate of RBBB decreased significantly(P﹤0.05); But the incidence rate of RBBB in all patients with ASD had no significance change between the 3 days, 1,3 and 6 months(P﹥0.05). Compared to pre-procedure,the electrical axis toward the right incidence rate decreased significantly in 1,3 and 6 months after the procedure,P<0.01.(2) Of the patients with VSD, compared with the pre-procedure, 3 days later, the incidence rate of RBBB/LBBB increased significantly(P﹤0.05). But 3 and 6 months later, the incidence rate of RBBB/LBBB decreased significantly(P﹤0.05).(3) Of the patients with PDA, compared with the pre-procedure,the incidence rate of LVH decreased significantly in the 3 and 6 months after the procedure(P﹤0.01); The electrical axis toward the left incidence rate decreased significantly in the 3 and 6 months after the procedure, P<0.01. 2 The changes of the parameters of the
方法成功施行经皮导管封堵术的先心病患者111例,其中ASD47例,VSD44例,PDA20例。通过TTE、ECG及动态心电图,观察先心病患者经导管封堵术前、术后心电参数、心室形态和功能超声指标。
结果1、经皮导管封堵术后心电变化:(1)与ASD封堵术前比较,术后3天、1个月、3个月及6个月的RBBB发生率明显减少(P均﹤0.05),但患者术后3天、1个月、3个月及6个月之间的RBBB发生率无明显差别(P均﹥0.05)。与ASD封堵术前比较,术后1个月、3个月及6个月的电轴右偏发生率明显减少(P均﹤0.01)。(2)与VSD封堵术前比较,术后3天的RBBB/LBBB发生率明显增多(P均﹤0.05),但患者术后3个月及6个月的RBBB/LBBB发生率又逐渐减少至正常(P均﹤0.05)。(3)与PDA封堵术前比较,患者术后3个月、6个月的LVH发生率均明显下降(P均﹤0.01),术后1个月、3个月、6个月的电轴左偏发生率均明显下降(P均﹤0.01)。2、经皮导管封堵术后动态心电图参数改变:(1)ASD封堵术后患者平均心率、室上性早搏、室性早搏及房性心律失常发生率与术前相比无明显差别(P均﹥0.05)。(2)VSD封堵术后患者平均心率、室上性早搏、室性早搏与术前相比无明显差别(P均﹥0.05),但术后2天内阵发性室性心动过速发生率明显多于术前(P均﹤0.01)。(3)PDA封堵术后患者平均心率、室上性早搏、室性早搏及房性心律失常发生率与术前相比无明显差别(P均﹥0.05)。3、经皮导管封堵术后心室形态及功能改变:(1)、与ASD封堵术前相比较,ASD患者术后1个月、3个月及6个月的LVED、LVEDD、LVSD及LVESD均明显增加(P均﹤0.05),RVED、RVOTD明显缩小(P均﹤0.01);但患者术后1个月、3个月及6个月之间LVED、LVEDD、LVSD、
Objectives To investigate the changes of electrophysiology and ventricular form, function after transcatheter device closure of ASD, VSD and PDA.And evaluate the effect on the electrophysiology and ventricular-remodeling after procedure in patients with congenital heart disease.
Methods 111 patients underwent procedure successfuly, 47 was ASD,44 was VSD and 20 was PDA. All patients were performed 12 lead- synchronous surface electrocardiogram, Ambulatory Holter monitoring and TTE study, analysised the parameters of electrocardic and the indexs of ventricular form and function pre- and after- procedure.
Results 1 The changes of electrophysiology after procedure. (1) In patients with ASD, compared with the pre-procedure, 3 days,1,3 and 6 months later, the incidence rate of RBBB decreased significantly(P﹤0.05); But the incidence rate of RBBB in all patients with ASD had no significance change between the 3 days, 1,3 and 6 months(P﹥0.05). Compared to pre-procedure,the electrical axis toward the right incidence rate decreased significantly in 1,3 and 6 months after the procedure,P<0.01.(2) Of the patients with VSD, compared with the pre-procedure, 3 days later, the incidence rate of RBBB/LBBB increased significantly(P﹤0.05). But 3 and 6 months later, the incidence rate of RBBB/LBBB decreased significantly(P﹤0.05).(3) Of the patients with PDA, compared with the pre-procedure,the incidence rate of LVH decreased significantly in the 3 and 6 months after the procedure(P﹤0.01); The electrical axis toward the left incidence rate decreased significantly in the 3 and 6 months after the procedure, P<0.01. 2 The changes of the parameters of the
引文
1 刘薇廷,宁寿葆,华邦杰,等.上海市杨浦、徐汇区小儿先天性心脏病发病率及其特点[J].实用儿科临床杂志,1995,33(6):347-349.
2 JW Moore, L George, SE Kirkpatrick, JW Mathewson, RL Spicer, K Uzark, A Rothman, PA Cambier. Etal. Percutaneous closure of the small patent ductus arteriosus using occluding spring coils [J]. J Am Coll Cardiol, 1994; 23:759-765
3 Fischer G, Stieh J, Huffmann U, Et al. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder:a single centre study in 236 consecutive patients. Heart, 2003,89:199-204
4 Holzer R, Balzer D, Cao QL, Etal. Device closure of muscular ventricular septal defects using the Amplatzer muscular ventricular septal defect occluder: immediate and mid-term results of a US registry. J Am Coll Cardiol , 2004,43:1257–1263
5 Thanopoulos BD, Tsaousis GS, Karanasios E, Etal.: Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer asymmetric ventriculars eptal defect occluder: preliminary experience in children. Heart, 2003,89:918–922
6 Harrison DA, Benson LN, Lazzam C, Et al. Percutaneous catheter closure of the persistently patent ductus arteriosus in the adult. Am J Cardiol, 1996,77:1094-97
7 秦永文,赵先仙,吴弘,等. 国产封堵器治疗膜周部室间隔缺损 284 例的疗效评价。介入放射学杂志,2004,vol 12, suppl(2)
8 石继军,曾国洪,张智伟,等. 国产动脉导管封堵器的临床应用及疗效评价。中华放射学杂志,2003,Vol 37, No. 8
9 雷云,张伟华,丁云川,等. 国产封堵器治疗房间隔缺损疗效评价。中国介入心脏病学杂志,2003, Vol 11, No.2(2003, 11: 68-70)
10 Veldtman GR, Razack V, Siu S, et al. Right ventricular form and function after percutaneous atrial septal defect device closure[J]. J AM Coll Cardiol, 2001,37:2108-2113.
11 Hill SL, Berul C L, Patel HT, et al. Early ECG abnormalities associated with transcatheter closure of atrial septal defect using the Amplatzer septal occluder[J]. Journal of interventional cardiac electrophysiology 2000;4:469-474.
12 孙宪军,高伟,周爱卿,等. 膜周部室间隔缺损经导管封堵术后早期心律失常危险因素的探讨,中华儿科杂志 2005;43(10): 767-771
13 Galal MO, Amin M, Hussein A, Et al. Left Ventricular Dysfunction after Closure of Large Patent Ductus Arteriosus. Asian Cardiovasc Thorac Ann 2005;13:24-29
14 刘延玲,熊鉴然. 临床超声心动图学。 北京-科学出版社,2001-7(第一版)
15 Harrigan RA, Jones K. Conditions affecting the right side of the heart. British Medical Journal[J]. 2002, 324:1201-1204.
16 Berger F, Vogel M , Kramer A , et al . Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg 1999;68:75-8
17 Michael A G , Marc A F, Samuel C S , et al.Atrial arrhythmia after surgical closure of atrial septal defect in adults. N Engl J Med 1999;340:839-46
18 Morton B, Sanders P, Vohra K,et al. Effect of chronic right atrial stretch on atrial electrical remodeling in Patients With an atrial septal defect. Circulation. 2003;107:1775-1782
19 郭继鸿. 心电图学.第一版.北京;人民卫生出版社, 2002,11,239
20 Ficher G, Stieh J, Uebing A, Et al. Experience with transcatheter closure of secundum atrial sepal defects using the Amplatzer septal occluder:a single centre study in 236 consecutive patients. Heart 2003;89:199-204
21 李寰,张玉顺,吴栋梁等。Amplatzer房间隔封堵器治疗200例的并发症,心脏杂志 2003,15(6)
22 蒋世良,徐仲英,黄连军等。采用Amplatzer封堵器介入治疗继发孔房间隔缺损的并发症的防治,中国介入心脏病学杂志 2004,vol 12,No 6
23 Wolfe R R. Driscoll D J. Gersony W M, Et al. Report From the Second Joint Study on the Natural History of Congenital Heart Defects (NHS-2): Arrhythmias in Patients With Valvar Aortic Stenosis, Valvar Pulmonary Stenosis, and Ventricular Septal Defect: Results of 24-Hour ECG Monitoring. Circulation 1993;87(suppl I):I-89-I-101
24 赵康丽, 虞敏, 刘楠. 心脏外科直视术后心律失常的发生率及其危险因素分析. 中华心律失常学杂志 2004,8(6):375-376
25 Sideris B, Walsh P, Haddad L, Et al. Occlusion of congenital ventricular septal defects by the buttoned device.Heart 1997;77:276-279
26 张玉顺,李寰,代政学等。膜周部室间隔缺损介入治疗的临床评价,中国循环杂志 2005,20:14
27 Alpert JS. The effect of right ventricular dysfunction on left ventricular form and function. Chest, 2001,119:1632-1633
28 Brochu M, Baril J, Dore A, Et al. Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation, 2002,106:1821-1826
29 Salehian O, Horlick E, Schwerzmann M, Et al. Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. J AM Coll Cardiol, 2005,45:499-504
30 Pesrlman AS,Borer JS,Clark CE. Abnormal right ventricular size and ventricular septal motion after atrial septal defect closure:etiology and functional significance. Am J Cardiol,1978,41:295-301
31 Braunwald 主编, 陈灏珠主译. 心脏病学[M]. 第 5 版. 北京: 人民卫生出版社, 2001, 363.
32 马红,郭好学,杨丽娟等. 室间隔缺损封堵术后左心功能的超声评价. 实用医学影像杂志, 2004,5:101-103
33 Jarmakani MM, Garham TP, Canent RV, Et al. Effect of Site of Shunt on Left Heart- Volume Characteristics in Children withV entricular Septal Defect and Patent Ductus Arteriosus. Circulation 1969;XL:411-418
34 Galal MO, Amin M, Hussein A, Et al. Left Ventricular Dysfunction after Closure of Large Patent Ductus Arteriosus. Asian Cardiovasc Thorac Ann 2005;13:24-29
35 倪显达, 卢中秋, 徐湘挺等. 超声心动图评价动脉导管未闭 Amplatzer 封堵器治疗前后心功能的变化. 中国超声医学杂志, 2002,18: 947-751
36 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.第四军医大学学报. 2002;23(14):1321-1322
1 Berger F, Vogel M , Kramer A , et al . Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg 1999;68:75-8
2 Michael A G , Marc A F, Samuel C S , et al.Atrial arrhythmia after surgical closure of atrial septal defect in adults. N Engl J Med 1999;340:839-46
3 Morton B, Sanders P, Vohra K,et al. Effect of chronic right atrial stretch on atrial electricalremodeling in Patients With an atrial septal defect. Circulation. 2003;107:1775-1782
4 Wolfe R R.. Driscoll D J. Gersony W M, Et al. Report From the Second Joint Study on the Natural History of Congenital Heart Defects (NHS-2): Arrhythmias in Patients With Valvar Aortic Stenosis, Valvar Pulmonary Stenosis, and Ventricular Septal Defect: Results of 24-Hour ECG Monitoring. Circulation 1993;87(suppl I):I-89-I-101
5 John K T. Arrhythmias in adults with congenital heart disease. Heart 2002;87:383-389
6 Steven B, Wernovsky G, Thomas L, Et al. Factors that influence the development of atrial flutter after the Fontan operation. Thorac cardiovasc surg 1997; 113:80-086
7 Edward P W. Arrhythmias in patients with congenital heart disease . Cardiac Eletrophysiology Review; 2002;6(4)
8 Kurer CC,Tanner CS,Vetter VL. Electrophysiologic findings after Fontan repair of functional single ventricle. J Am Coll Cardiol. 1991 Jan; 17(1): 174-81
9 Hill.L, Berul.I, Patel T, Et al:Early ECG abnormalities associated with transcatheter closure of atrial septal defects using the Amplatzer septa occluder,Journal of interventional Caidiac electrophysiology;Oct 2000;4,3
10 Ficher G, Stieh J, Uebing A, Et al. Experience with transcatheter closure of secundum atrial sepal defects using the Amplatzer septal occluder:a single centre study in 236 consecutive patients. Heart 2003;89:199-204
11 李寰,张玉顺,吴栋梁等。Amplatzer房间隔封堵器治疗200例的并发症,心脏杂志 2003,15(6)
12 蒋世良,徐仲英,黄连军等。采用Amplatzer封堵器介入治疗继发孔房间隔缺损的并发症的防治,中国介入心脏病学杂志 2004,vol 12,No 6
13 Sideris B, Walsh P, Haddad L, Et al. Occlusion of congenital ventricular septal defects by the buttoned device. Heart 1997;77:276-279
14 Thanopoulos BD, Tsaousis GS, Karanasios E, Eleftherakis N G, Paphitis C. Transcatheter closure of perimembranous ventricular septal defects with the amplatzer asymmetric ventricular septal defect occluder: preliminary experience in children. Heart 2003;89:918-922
15 张玉顺,李寰,代政学等。膜周部室间隔缺损介入治疗的临床评价,中国循环杂志 2005,20:14
16 秦永文,赵仙先,吴弘等。国产封堵器治疗膜周部室间隔缺损284例的疗效评价,介入放射学杂志 2004,vol 12,Suppl (2)
17 全薇,朱鲜阳,张玉威等。动脉导管未闭 6 3 例封堵术前、后心电图对比分析,心脏杂志 2002;14(3)
2 JW Moore, L George, SE Kirkpatrick, JW Mathewson, RL Spicer, K Uzark, A Rothman, PA Cambier. Etal. Percutaneous closure of the small patent ductus arteriosus using occluding spring coils [J]. J Am Coll Cardiol, 1994; 23:759-765
3 Fischer G, Stieh J, Huffmann U, Et al. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder:a single centre study in 236 consecutive patients. Heart, 2003,89:199-204
4 Holzer R, Balzer D, Cao QL, Etal. Device closure of muscular ventricular septal defects using the Amplatzer muscular ventricular septal defect occluder: immediate and mid-term results of a US registry. J Am Coll Cardiol , 2004,43:1257–1263
5 Thanopoulos BD, Tsaousis GS, Karanasios E, Etal.: Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer asymmetric ventriculars eptal defect occluder: preliminary experience in children. Heart, 2003,89:918–922
6 Harrison DA, Benson LN, Lazzam C, Et al. Percutaneous catheter closure of the persistently patent ductus arteriosus in the adult. Am J Cardiol, 1996,77:1094-97
7 秦永文,赵先仙,吴弘,等. 国产封堵器治疗膜周部室间隔缺损 284 例的疗效评价。介入放射学杂志,2004,vol 12, suppl(2)
8 石继军,曾国洪,张智伟,等. 国产动脉导管封堵器的临床应用及疗效评价。中华放射学杂志,2003,Vol 37, No. 8
9 雷云,张伟华,丁云川,等. 国产封堵器治疗房间隔缺损疗效评价。中国介入心脏病学杂志,2003, Vol 11, No.2(2003, 11: 68-70)
10 Veldtman GR, Razack V, Siu S, et al. Right ventricular form and function after percutaneous atrial septal defect device closure[J]. J AM Coll Cardiol, 2001,37:2108-2113.
11 Hill SL, Berul C L, Patel HT, et al. Early ECG abnormalities associated with transcatheter closure of atrial septal defect using the Amplatzer septal occluder[J]. Journal of interventional cardiac electrophysiology 2000;4:469-474.
12 孙宪军,高伟,周爱卿,等. 膜周部室间隔缺损经导管封堵术后早期心律失常危险因素的探讨,中华儿科杂志 2005;43(10): 767-771
13 Galal MO, Amin M, Hussein A, Et al. Left Ventricular Dysfunction after Closure of Large Patent Ductus Arteriosus. Asian Cardiovasc Thorac Ann 2005;13:24-29
14 刘延玲,熊鉴然. 临床超声心动图学。 北京-科学出版社,2001-7(第一版)
15 Harrigan RA, Jones K. Conditions affecting the right side of the heart. British Medical Journal[J]. 2002, 324:1201-1204.
16 Berger F, Vogel M , Kramer A , et al . Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg 1999;68:75-8
17 Michael A G , Marc A F, Samuel C S , et al.Atrial arrhythmia after surgical closure of atrial septal defect in adults. N Engl J Med 1999;340:839-46
18 Morton B, Sanders P, Vohra K,et al. Effect of chronic right atrial stretch on atrial electrical remodeling in Patients With an atrial septal defect. Circulation. 2003;107:1775-1782
19 郭继鸿. 心电图学.第一版.北京;人民卫生出版社, 2002,11,239
20 Ficher G, Stieh J, Uebing A, Et al. Experience with transcatheter closure of secundum atrial sepal defects using the Amplatzer septal occluder:a single centre study in 236 consecutive patients. Heart 2003;89:199-204
21 李寰,张玉顺,吴栋梁等。Amplatzer房间隔封堵器治疗200例的并发症,心脏杂志 2003,15(6)
22 蒋世良,徐仲英,黄连军等。采用Amplatzer封堵器介入治疗继发孔房间隔缺损的并发症的防治,中国介入心脏病学杂志 2004,vol 12,No 6
23 Wolfe R R. Driscoll D J. Gersony W M, Et al. Report From the Second Joint Study on the Natural History of Congenital Heart Defects (NHS-2): Arrhythmias in Patients With Valvar Aortic Stenosis, Valvar Pulmonary Stenosis, and Ventricular Septal Defect: Results of 24-Hour ECG Monitoring. Circulation 1993;87(suppl I):I-89-I-101
24 赵康丽, 虞敏, 刘楠. 心脏外科直视术后心律失常的发生率及其危险因素分析. 中华心律失常学杂志 2004,8(6):375-376
25 Sideris B, Walsh P, Haddad L, Et al. Occlusion of congenital ventricular septal defects by the buttoned device.Heart 1997;77:276-279
26 张玉顺,李寰,代政学等。膜周部室间隔缺损介入治疗的临床评价,中国循环杂志 2005,20:14
27 Alpert JS. The effect of right ventricular dysfunction on left ventricular form and function. Chest, 2001,119:1632-1633
28 Brochu M, Baril J, Dore A, Et al. Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation, 2002,106:1821-1826
29 Salehian O, Horlick E, Schwerzmann M, Et al. Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. J AM Coll Cardiol, 2005,45:499-504
30 Pesrlman AS,Borer JS,Clark CE. Abnormal right ventricular size and ventricular septal motion after atrial septal defect closure:etiology and functional significance. Am J Cardiol,1978,41:295-301
31 Braunwald 主编, 陈灏珠主译. 心脏病学[M]. 第 5 版. 北京: 人民卫生出版社, 2001, 363.
32 马红,郭好学,杨丽娟等. 室间隔缺损封堵术后左心功能的超声评价. 实用医学影像杂志, 2004,5:101-103
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