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目的:探讨左向右分流型先天性心脏病(先心病)继发肺动脉高压(PAH)的相关因素,并研究房间隔缺损(ASD)不同年龄术后右心形态恢复情况。方法:回顾性分析经导管介入治疗ASD、动脉导管未闭(PDA)、室间隔缺损(VSD)患者的性别、年龄、心内异常通道大小、体重、有无并发其他心内畸形及有无发生肺动脉高压等资料,并对其中91例ASD患者术前3 d及术后3 d、3个月、6~12个月作超声心动图随访。结果:心内异常通道大小对左向右分流型先心病继发PAH有影响(OR1.1~1.3),ASD中≥40岁组OR4.1,P=0.008。介入术后ASD患者右心均有恢复,但≥40岁组术后3~12个月右心大小无进一步的缩小。结论:心内异常通道大小是左向右分流型先心病继发PAH的主要影响因素,在低压腔间分流性心脏病中年龄亦是影响PAH进展的另一重要因素,40岁前对ASD进行纠治心脏恢复较好。
Objective: To investigate the related factors of secondary pulmonary hypertension (PAH) in left-to-right shunt congenital heart disease (CHD) and to study the morphological changes of right ventricular after different ages of atrial septal defects (ASD). Methods: The gender, age, intracardiac abnormal channel size, body weight, presence or absence of other intracardiac malformations and their presence or absence in patients with ASD, patent ductus arteriosus (PDA) and ventricular septal defect (VSD) were retrospectively analyzed. Pulmonary hypertension and other data, and 91 cases of ASD patients were preoperative 3 d and 3 d, 3 months, 6 to 12 months after echocardiographic follow-up. Results: The size of abnormal heart channel had an effect on secondary PAH in left-right shunt congenital heart disease (OR1.1 ~ 1.3), OR4.1 in ≥40 years ASD group, P = 0.008. After intervention, ASD patients recovered right heart, but the size of right heart did not decrease further in 3 ~ 12 months postoperatively in 40-year-old group. Conclusions: The size of intracardiac anomalous channel is the main influencing factor of secondary PAH in left-to-right shunt congenital heart disease. Another important factor influencing the progression of PAH is the age of low-pressure intercavitary heart disease. ASD is performed before the age of 40 Correction of heart recovery is better.