Remodelling after surgical repair of atrial septal defects within the oval fossa
Remodelling after surgical repair of atrial septal defects within the oval fossa
复制标题
卵圆窝内房间隔缺损手术修复后的重塑
作者：
C. A. Attenhofer Jost;E. Oechslin;B. Seifert;Friedrich Maly;R. Fatio;J. Turina;R. Jenni
在一项回顾研究中，我们分析了101名成年人的超声心动图随访数据，这些患者在卵圆窝内的缺陷手术修复后，平均年龄为35±17岁，其中56%的人年龄在30岁以上。平均随访年龄44±18岁，平均随访时间40年(11±12年)。随访时，1/4出现心房颤动或扑动。右心房扩张(%)、左心房扩张(44%)、右室扩张(29%)、肺动脉高压(30%)也较常见。相反，右室射血分数减少是非常罕见的，只有1%的人发现，而且没有发现异常的左心室射血分数。多因素分析显示，年龄、三尖瓣返流程度、肺动脉高压和/或心房颤动是右、左心房或右心室扩张的预测因素。在21例窦性心律患者中，我们前瞻性地将两室舒缩功能与脑利钠肽水平相关，并与平均年龄为46±14岁的20名年龄匹配的对照组进行比较。脑钠尿肽水平显著高于对照组(p=0.006)，并与舒张期功能障碍(p=0.007)和左房大小(p<；0.0001)显著相关。因此，在手术修复卵圆窝内缺损后的长期随访中，心脏大小和功能完全正常化的情况很少见。尽管收缩功能得到了保护，但持续性的舒张期功能障碍是常见的，并与脑钠素水平升高有关，这可能是房性心律失常晚期发生的原因。
In a retrospective study, we analysed the data from 101 adults with echocardiographic follow-up after surgical repair of defects within the oval fossa at a mean age of 35 ± 17 years; 56% of the cohort being above the age of 30 years. Mean age at follow-up was 44 ± 18 years, and length of follow-up was up to 40 years (11 ± 12 years). At follow-up, atrial fibrillation or flutter was present in one quarter. Dilation of the right atrium, found in 64%, of the left atrium, found in 44%, and of the right ventricle, found in 29%, were also frequent, as well as pulmonary arterial hypertension, which was found in 30%. Diminished right ventricular ejection fraction, in contrast, was very rare, found only in 1%, and abnormal left ventricular ejection fraction was not encountered. By multivariate analysis, predictors for right or left atrial, or right ventricular, dilation were age at follow-up, degree of tricuspid regurgitation, pulmonary hypertension, and/or atrial fibrillation. In a subset of 21 patients in sinus rhythm, we correlated prospectively the diastolic and systolic function of both ventricles with levels of brain natriuretic peptide, comparing values to those of 20 age-matched controls with a mean age of 46 ± 14 years. Levels of brain natriuretic peptide were significantly higher in patients than in controls (p = 0.006), and correlated significantly with diastolic dysfunction (p = 0.007) and left atrial size (p < 0.0001). In the long-term follow-up after surgical repair of defect within the oval fossa, therefore, complete normalization of heart size and function is rare. Despite preserved systolic function, persistent diastolic dysfunction is common and is associated with elevated levels of brain natriuretic peptide, which may explain the late occurrence of atrial arrhythmias.
成人房间隔缺损的右心室功能。
DOI：
10.1016/0002-9149(81)90289-7
发表时间：
1981
期刊：
The American journal of cardiology
影响因子：
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作者：
Liberthson,RR;Boucher,CA;Strauss,HW;Dinsmore,RE;McKusick,KA;Pohost,GM
通讯作者：
Pohost,GM