Changes of cardiac structure and pulmonary arterial systolic pressure after transcatheter closure for atrial septal defect associated with pulmonary arterial hypertension in Tibetan patients
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摘要: 目的:探讨高原地区藏族房间隔缺损(ASD)合并肺动脉高压(PAH)患者介入封堵术后心脏结构及肺动脉收缩压(PASP)的变化,并与汉族患者进行比较。方法:106例接受介入封堵治疗的ASD-PAH患者(年龄≥18岁)根据民族分为藏族组(41例)和汉族组(65例),分别在术前、术后3 d、术后3个月进行经胸超声心动图(TTE)检查,比较两组PASP及心脏结构的改变。结果:术前藏族患者主肺动脉内径(MPAD)大于汉族患者(P＜0.05),PASP低于汉族患者(P＜0.05)。术后3 d两组患者MPAD均较术前缩小,PASP降低(P＜0.05),且藏族PASP的下降程度优于汉族(P＜0.05),这种优势持续到术后3个月。术后3 d两组患者右房、右室内径均较术前缩小,左室舒张末内径增大(P＜0.05);术后3个月藏族患者右房、右室内径进一步缩小(P＜0.05),而左室舒张末内径在两组患者中均较术后3 d进一步增大(P＜0.05)。结论:高原地区藏族成人ASD-PAH患者介入封堵治疗纠正缺损畸形可有效缓解PAH,改善心脏结构,其短期疗效优于汉族患者,可能与世居藏族的遗传优势及高原适应性有关。Abstract: Objective: To evaluate the changes of cardiac structure and pulmonary arterial systolic pressure (PASP) after transcatheter closure for atrial septal defect (ASD)associated with pulmonary arterial hypertension(PAH) in Tibetan patients,and compare with Han patients. Method: A total of 106 patients ( 41 Tibetans and 65 Hans, age≥18 years) with ASD-PAH were included in the study. All patients underwent echocardiographic examination before and 3 days, 3 months after transcatheter closure.Result: The main pulmonary artery diameter (MPAD) was larger while the PASP was lower in Tibetan patients than that in Han patients (P＜0.05) before the procedure. The MPAD and PASP were decreased significantly in both groups 3 days after the transcatheter closure of ASD (P＜0.05) and the decrease of PASP in Tibetan was better than that in Han (P＜0.05). Also, this preponderance went on to 3 months after the procedure. The right atrial diameter (RAD) and the right ventricular diameter (RVD) were decreased while the left ventricular end-systolic diameter (LVESD) was increased in both groups 3 days after the procedure (P＜0.05). Comparing with 3 days after the procedure, the RAD and RVD decreased in Tibetan patients at 3 months follow-up (P＜0.05) while there was no significantly difference in Han patients. The LVESD decreased in both groups at 3 months follow-up. Conlusion: Transcatheter closure of ASD is an effective method to decrease the PASP and optimize the cardiac structure for Tibetan adult ASD-PAH patients in plateau and the short-term effects is better in Tibetan than that in Han. It may be caused by genetic advantage and high altitude adapation of Tibetans.
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Key words:
- atrial septal defect /
- pulmonary arterial hypertension /
- Tibetan
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