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目的:探讨存在左心室扩大的动脉导管未闭(patent ductus arteriosus,PDA)患者封堵术后左心室(left ventricular,LV)大小和功能变化规律。方法:以伴左心室扩大的青少年和成人PDA患者为研究对象,成功封堵PDA后定期随访LV大小和功能。术后24 h LV内径恢复正常者随访6个月;术后24 h未恢复正常者,随访至LV内径恢复正常。结果:共纳入患者391例,男63例,年龄(35±16)岁,PDA肺动脉端直径(7±2)mm。失访36(9.2%)例。封堵术后次日左心室大小和射血分数(LVEF)均明显减小(P<0.05)。术后次日,1,3,6和12个月LV大小恢复正常者分别为140(35.8%)例,108(30.4%)例,38(10.7%)例,23(6.5%)例和11(3.1%)例。12个月时LV内径未恢复正常35例(9.9%),其中7例于术后1.5~4年恢复正常,28例随访1~4.5年,LV大小仍未恢复正常。术后次日LV内径恢复正常和12个月仍未恢复正常患者,LVEF均于术后半年恢复至术前水平。结论:对于伴有LV增大的PDA患者,封堵术可致LVEF下降,术后需6个月方缓慢恢复,部分患者封堵术后需数年LV方能恢复正常大小。
Objective: To investigate the changes of left ventricular (LV) size and function in patients with patent ductus arteriosus (PDA) with left ventricular enlargement. Methods: The PDA patients with enlarged left ventricle and adults with PDA were enrolled in this study. The size and function of LV were regularly followed up after PDA was successfully occluded. At 24 hours after operation, the patients whose LV internal diameter returned to normal were followed up for 6 months. Those who did not recover to normal after 24 hours were followed up until the LV internal diameter returned to normal. Results: A total of 391 patients were enrolled, including 63 males (35 ± 16) years of age and PDA (7 ± 2) mm in diameter. Loss of follow-up 36 (9.2%) cases. Left ventricular volume and ejection fraction (LVEF) were significantly reduced the day after closure (P <0.05). The LV size returned to normal at 1, 3, 6 and 12 months after surgery respectively in 140 (35.8%), 108 (30.4%), 38 (10.7%), 23 (3.1%) cases. At 12 months, LV diameter did not recover to normal in 35 cases (9.9%), of which 7 returned to normal after 1.5 to 4 years and 28 cases were followed up for 1 to 4.5 years. The size of LV remained normal. The LV diameter returned to normal on the next day after surgery and remained normal at 12 months. LVEF was restored to the preoperative level in six months after operation. Conclusion: For PDA patients with increased LV, LVEF can be decreased by occlusion. After 6 months, the LVEF should be slowly recovered. Some patients may recover to normal size after several years of occlusion.