Atrial Septal Defects - Clinical Manifestations, Echo Assessment, and Intervention
Atrial Septal Defects - Clinical Manifestations, Echo Assessment, and Intervention
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DOI：
10.4137/cmc.s15715
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发表时间：
2014-01-01
影响因子：
3
通讯作者：
Mukherjee, Monica
中科院分区：
文献类型：
--
作者：
Martin, Seth S.;Shapiro, Edward P.;Mukherjee, Monica
房间隔缺损（ASD）是一种常见的先天性畸形，其表现形式为分泌口、原发口、静脉窦，冠状窦缺损则少见。ASD的病理生理后果通常开始于成年期，包括心律失常、反常栓塞、脑脓肿、肺动脉高压和右心室衰竭。二维（2D）经胸超声心动图多普勒是一个中心方面的评价。这种非侵入性成像方式通常可以建立诊断并提供指导干预的关键信息。全面的超声心动图包括评估ASD的解剖特征、血流方向、相关异常（例如，异常肺静脉）、右心室解剖结构和功能、肺动脉压和肺/体循环血流比。ASD封堵的主要适应症是右心容量超负荷，无论是否存在症状。在其他情况下，ASD闭合也可能是合理的，例如反常栓塞。ASD类型和当地临床专业知识指导选择经皮与手术方法进行ASD闭合。
Atrial septal defect (ASD) is a common congenital abnormality that occurs in the form of ostium secundum, ostium primum, sinus venosus, and rarely, coronary sinus defects. Pathophysiologic consequences of ASDs typically begin in adulthood, and include arrhythmia, paradoxical embolism, cerebral abscess, pulmonary hypertension, and right ventricular failure. Two-dimensional (2D) transthoracic echocardiography with Doppler is a central aspect of the evaluation. This noninvasive imaging modality often establishes the diagnosis and provides critical information guiding intervention. A comprehensive echocardiogram includes evaluation of anatomical ASD characteristics, flow direction, associated abnormalities (eg, anomalous pulmonary veins), right ventricular anatomy and function, pulmonary pressures, and the pulmonary/systemic flow ratio. The primary indication for ASD closure is right heart volume overload, whether symptoms are present or not. ASD closure may also be reasonable in other contexts, such as paradoxical embolism. ASD type and local clinical expertise guide choice of a percutaneous versus surgical approach to ASD closure.