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目的:探讨年龄≥60岁的房间隔缺损(atrial septal defect,ASD)患者介入封堵治疗的安全性和有效性。方法:分析51例拟行ASD介入封堵术的年龄≥60岁患者的临床资料特征及手术效果,并与其他年龄段的成人ASD进行比较。结果:年龄≥60岁的ASD患者(60ASD)占成人ASD的7.9%(51/647例)。60ASD的房颤发生率(27.45%)明显高于18~60岁的ASD患者(59ASD)(3.52%)。60ASD与59ASD患者相比:心脏结构的重构改变更加明显,包括心房和心室增大更多,心腔内压力和肺血管阻力明显增高。但相关性分析显示,ASD患者年龄与肺动脉压力、左房内径、右房内径、左室舒张末内径、右室舒张末内径和肺阻力仅有较弱相关性(r分别为:0.263、0.500、0.215、0.174、0.153、0.335)。60ASD与59ASD患者的手术成功率和主要并发症发生率无差别。不论任何年龄段的患者,术后右心重构均明显改善,表现在右房右室过度充盈减轻,内径缩小;但是60ASD患者心脏重构的改善程度小于59ASD。结果:介入封堵治疗年龄≥60岁的ASD患者安全有效,术后患者心脏重构改善。
Objective: To investigate the safety and efficacy of interventional closure in patients with atrial septal defect (ASD) aged 60 years or older. Methods: Fifty-one patients with ASD who underwent ASD were enrolled in this study. The clinical data and surgical outcomes were compared with those of other age-matched adult ASDs. Results: ASD patients (60 ASD) ≥60 years of age accounted for 7.9% (51/647) adults with ASD. The incidence of atrial fibrillation in 60ASD (27.45%) was significantly higher than that in ASD patients aged 18-60 years (59ASD) (3.52%). 60ASD compared with 59ASD patients: cardiac remodeling changes more pronounced, including more atrial and ventricular enlargement, intracardiac pressure and pulmonary vascular resistance was significantly increased. However, the correlation analysis showed that there was only a weak correlation between ASD age and pulmonary artery pressure, left atrial diameter, right atrial diameter, left ventricular end-diastolic diameter, right ventricular end diastolic diameter and pulmonary resistance (r = 0.263,0.500, 0.215, 0.174, 0.153, 0.335). 60ASD and 59ASD patients in the surgical success rate and the main complication rate was no difference. Patients with any age group had a significant improvement in right ventricular remodeling after surgery, indicating over-filling of the right atrium and a reduction of the internal diameter. However, the improvement of cardiac remodeling in patients with 60ASD was less than 59ASD. Results: The ASD patients who were involved in the occlusion therapy of age ≥60 years were safe and effective, and the cardiac remodeling was improved after operation.