目的:探讨中老年继发孔型房间隔缺损(ASD)经导管封堵术后左、右心功能变化。方法:观察269例接受封堵治疗的40岁以上ASD患者术前和术后X线胸片、经胸超声心动图(TTE)和心电图变化。另选择同期30例健康查体的相同年龄和性别构成比对象作为超声指标的正常对照。结果:全组缺损TTE最大径平均17．7±5．3(5～30)mm,选用封堵器直径平均27．5±6．0(13～40)mm。心功能术后1天较术前、术后1个月较术后1天改善,有显著性差异(P<0．05～0．001)。心胸比率术后1天较术前、术后6个月较术后1个月缩小,有显著性差异(P<0．05～0．001)。心电图:右心房高负荷率、RV1+SV5、QRS间期、右束支传导阻滞比率术后1天较术前、术后1个月较术后1天,均有显著性差异(P<0．05～0．001)。超声心动图:右心室前后径,术后1天较术前、术后1个月较术后1天、术后6个月较术后1个月缩小,均有极显著性差异(P<0．01～0．001);主肺动脉内径术后1天较术前缩小,但术后6个月仍高于正常对照,有极显著性差异(P<0．001)。三尖瓣反流程度分级术后1天较术前、术后1个月较术后1天,均有显著性差异(P<0．05～0．001)。左心房前后径术前、术后无显著性变化。左心室舒张末期内径术后1天较术前、术后1个月较术后1天、术后6个月较术后1个月增加,均有极显著性差异(P<0．01～0．001),左心室射血分数术后1天较术前增加,有极显著性差异(P<0．001)。结论:封堵治疗能够有效降低中老年ASD右心内径和肺动脉收缩压,增加左心室内径,改善左心室收缩功能和心室电传导。近中期疗效满意,远期疗效有待于进一步观察。 Objective: To investigate the changes of left and right heart function in patients with secondary atrial septal defect (ASD) after middle and old age. Methods: Preoperative and postoperative X-ray, transthoracic echocardiography (TTE) and electrocardiogram (EEC) were observed in 269 ASD patients over 40 years old who received blockade therapy. Another 30 healthy subjects at the same time choose the same age and sex composition than the object as a normal control ultrasound. Results: The mean diameter of TTE was 17.7 ± 5.3 (5 ~ 30) mm in average and 27.5 ± 6.0 (13 ~ 40) mm in diameter. One day after operation, heart function improved more than preoperative one month and one month postoperatively, with significant difference (P <0.05-0.001). Cardiothoracic ratio 1 day after surgery than before surgery, 6 months after surgery compared with 1 month after surgery to reduce, there was a significant difference (P <0.05 ~ 0.001). ECG: right atrium high load rate, RV1 + SV5, QRS interval, right bundle branch block rate 1 day after surgery compared with preoperative and postoperative 1 month after surgery were significantly different (P < 0.05 ~ 0.001). Echocardiography: anteroposterior diameter of the right ventricle, 1 day after surgery than preoperative, 1 month after surgery than 1 day after surgery, 6 months after surgery compared with 1 month after surgery were significantly reduced (P < 0.01 ~ 0.001). The diameter of the main pulmonary artery decreased 1 day after operation compared with that before operation, but remained significantly higher than that of the control at 6 months after operation (P <0.001). Tricuspid regurgitation grading 1 day after surgery compared with preoperative and postoperative 1 month after 1 day, there was a significant difference (P <0.05 ~ 0.001). Before and after the left atrium before and after surgery no significant change. The left ventricular end-diastolic diameter at 1 day after operation was significantly higher than that before operation, 1 month after operation, 1 day after operation, 6 months after operation, and 1 month after operation (P <0.01 ~ 0.001), left ventricular ejection fraction 1 day after surgery increased compared with preoperative, there was a significant difference (P <0.001). Conclusion: Blocking therapy can effectively reduce the right ventricular diameter and pulmonary artery systolic pressure in middle-aged and elderly patients with ASD, increase the diameter of the left ventricle, and improve left ventricular systolic function and ventricular electrical conduction. Near and mid-term results are satisfactory, long-term efficacy remains to be further observed.