肺动脉压力正常及轻度增高的成年房间隔缺损患者心房水平隐性右向左分流探查

王琳; 赵红玲; 岳庆雄; 庞占琪; 董赫; 李亚文; 杨健; 马奔; 李世军

doi:10.13201/j.issn.1001-1439.2014.12.005

肺动脉压力正常及轻度增高的成年房间隔缺损患者心房水平隐性右向左分流探查

- 大连市中心医院心内科(辽宁大连, 116033)

详细信息

通讯作者: 李世军,E-mail:lshijun@126.com

中图分类号: R541.1

收稿日期: 2014-05-21

Inspection of the right-to-left shunt in adult auricular septal defect patients with norma and mild increased pulmonary arterial pressure

- Cardiac Electrophysiology Ward, Dalian Municipal Central Hospital, Dalian, Liaoning, 116033, China

More Information

Corresponding author: LI Shijun, E-mail: lshijun@126.com

Received Date: 21 May 2014

摘要

摘要: 目的:探查正常及轻度肺动脉压力增高的成年房间隔缺损(ASD)患者的右向左分流发生情况。方法:17例中央型ASD患者,男8例,女9例,年龄18~66(47±16)岁,均经胸心脏超声(TTE)检查诊断ASD、心房水平血流分流方向及肺动脉压力。封堵治疗前在静息状态及(或)Valsalva动作时行经颅多普勒超声(TCD)发泡试验联合TTE右心声学造影检查。所有患者在介入封堵治疗前通过右心导管测定肺动脉压力,在封堵治疗后即刻及术后3 d、1个月、3个月及6个月再次行TCD发泡试验联合TTE右心声学造影检查。结果:TTE证实房间隔缺损直径5~24 mm,所有患者心房水平左向右单向分流。11例患者静息TCD发泡试验联合TTE右心声学造影出现心房水平存在右向左分流,6例静息状态下检查未提示存在右向左分流患者Valsalva动作后均出现右向左分流现象。封堵治疗前经右心导管检查测得肺动脉压力(18~41)/(5~11)mmHg(1 mmHg=0.133 kPa)。所有患者均成功进行介入封堵治疗。1例患者在封堵治疗术后3 d、1个月、3个月存在少量右向左分流,术后6个月17例患者均未见心房水平分流存在。结论:正常及轻度肺动脉高压的ASD患者心房水平存在隐性右向左分流,介入封堵治疗后分流消失。TCD发泡试验联合TTE右心声学造影检查可准确判定心房水平右向左分流。
- 房间隔缺损 /
- 肺动脉压 /
- TCD发泡试验 /
- TTE右心声学造影 /
- 右向左分流
Abstract: Objective:To inspect the right-to-left shunt in adult auricular septal defect patients with norma and mild increased pulmonary arterial pressure. Method:We examed 17 central type atrial septal defect patients including 8 males and 9 females,18~66 (47±16)years old. All patients were detected the auricular septal defect, atrial level shunt flow direction and pulmonary artery pressure using transthoracic echocardiography. All the patients did transcranial Doppler ultrasound (TCD) foaming test and TTE right heart contrast echocardiography examination while rest and or doing Valsalva action before, 3 days, 1 month, 3 months and 6 months after closure, and also detected the pulmonary artery pressure before closure using right heart catheter. Result: The diameters of atrial septal defect were 5~24 mm. Normal pulmonary artery pressure were detected in 4 patients and mild increased pulmonaryartery pressure were detected in 13 patients. Left to right shunt in atrial were detected in all patients. Using transcranial Doppler ultrasound foaming test and TTE right heart contrast echocardiography examination, 11 patients were detected right to left shunt in atrial while rest, and 6 patients were not. But the 6 patients were all found right to left shunt in atrial when doing Valsalva action. Pulmonary artery pressure were 18~41/5~11 mmHg (1 mmHg=0.133 kPa) which were examined using right heart catheter before closure. All patients underwent successful interventional therapy. We detected a small amount shunt from right to left in atrial in one patient 3 days, 1 month and 3 months after interventional therapy. Six months after closure no shunt in atrial was found. Conclusion:There are recessive right to left shunt in atrial in adult with normal and mild pulmonary arterial hypertension. The shunt disappeares after interventional therapy. Doppler ultrasound (TCD) foaming test and TTE right heart contrast echocardiography examination can accurate diagnosis the right to left shunt in atria in these patients.
- atrial septal defect /
- pulmonary arterial pressure /
- Doppler ultrasound foaming test /
- TTE right heart contrast echocardiography examination /
- right to left shunt

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参考文献(8)

[1]	JAUSS M, ZANETTE E.Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography[J].Cerebrovasc, 2000, 10:490-496.
[2]	MAFFES, DELLAVESA P, ZENONE F, et al.Transthoracic second harmonic two-and three-dimensional echocardiography for detection of patent foramen ovale[J].Eur J Echocardiogr, 2010, 11:57-63.
[3]	中国医师协会心血管内科分会先心病工作委员会.常见先天性心脏病介入治疗中国专家共识一、房间隔缺损介入治疗[J].介入放射学杂志, 2011, 20(1):3-9.
[4]	张潭,张晶,马小静,等.超声心动图监护下心导管介入与经胸小切口手术治疗小儿房间隔缺损的比较[J].临床心血管病杂志, 2012, 234(12):29-31.
[5]	THANIGARAJ S, VALIKA A, ZAJARIAS A, et al.Comparison of transthoracic versus transesophageal echocardiography for detection of right-to-left atrial shunting using agitated saline contrast[J].Am J Cardiol, 2005, 96:1007-1010.
[6]	LAO A Y, SHARMA V K, TSIVGOULIS G, et al.Detection of right-to-left shunts:comparison between the International Consensus and Spencer Logarithmic Scale criteria[J].Neuroimaging, 2008, 18:402-406.
[7]	KAI H, KOYANAGI S, HIROOKA Y, et al.Rightto-left shunt across atrial septal defect related to tricuspid regurgitation:assessment by transesophageal Doppler echocardiography[J].Am Heart J, 1994, 127:578-584.
[8]	LUERMANS J G, POST M C, TEMMERMAN F, et al.Is a predominant left-to-right shunt associated with migraine?A prospective atrial septal defect closure study[J].Catheter Cardiovasc Interv, 2009, 74:1078-1084.