The Clinical Research Of Atrial Septal Defect Patients With Pumonary Arterial Hypertension In Adults

Objective:To review the clinical data of secundum atrial septal defect (ASD) patients with pulmonary arterial hypertension in adults accepted intervention block treated, explore clinical characteristics and the association between platelet activation indicators in blood and pulmonary artery hypertension (PAH).Methods:A total of 481 patients with secundum ASD who accepted percutaneous closure of atrial septal defect or right heart catheterization examination in the first affiliated hospital of guangxi medical university from January 2003 to 2014 August were enrolled. According to mean pulmonary arterial pressure (mPAP) the patients was divided into two groups:normal pulmonary arterial pressure (NPAP) group (mPAP<25mmHg) and PAH group (mPAP≥25mmHg).Retrospective research method was applied to two groups clinical symptoms, electrocardiogram (ECG) parameters, the transthoracic echocardiography (TTE),right heart catheterization parameters and platelet activation indicators.Results:1. There were no significant differences between the PAH and NPAP groups in clinical symptoms of exertional palpitations and shortness of breath, chest pain, fatigue, dizziness or headaches, lower extremity edemaage(P>0.05). But there was significantly higher rate of tricuspid systolic murmur in the PAH group than the NPAP group (P<0.05). There was one patient with syncope in the PAH group which had accounting for only 1.1% of the total number of the group (1/92).2. There were no significant differences between the PAH and NPAP groups in the ECG of complete right bundle branch block (CRBBB) incomplete right bundle branch block (IRBBB), I° atrioventricular block (I°AVB), atrial tachycardia (AT), atrial premature, premature ventricular contractions, right axis deviation (P> 0.05). But there was significantly higher incidence of atrial fibrillation (AF), right ventricular hypertrophy and right atrial enlargement in the PAH group than the NPAP group (P<0.05).3. The PAH group demonstrated a significantly larger ASD diameter, left atrial diameter (LAD),right atrial diameter (RAD) and right ventricular diameter(RVD) than the NPAP group (P< 0.05).4. The PAH group demonstrated a significantly higher mean right atrial pressure(mRAP), mean right ventricular pressure(mRVP) and Qp/Qs ratio than the NPAP group (P< 0.05).5. Mean platelet volume (MPV) and Platelet distribution width (PDW)levels were significantly higher in the PAH group than the NPAP group (P<0.05).6. There were significant, positive correlations between MPV and mPAP(r= 0.551, P<0.05), MPV and right ventricular diameter(r= 0.237, P<0.05) in the PAH group.7. Age (odds ratio 1.030,95% confidence interval 1.003-1.059, P<0.05), ASD diameter (odds ratio 1.107,95% confidence interval 1.042-1.176, P<0.05),and MPV level (odds ratio 4.473,95% confidence interval 2.505-6.019, P<0.05) were independent risk factors of PAH in adult patients with ASD at multivariate logistic regression analysis.Condusion:1. ASD patients with PAH in adults dominated mainly mild PAH and were lack of specific clinical symptoms, but dominated higher rate of tricuspid systolic murmur.2. ASD patients with PAH in adults dominated higher rate of atrial fibrillation, right ventricular hypertrophy, and right atrial enlargement in the ECG 3. ASD patients with PAH in adults dominated larger defect size, left atrial diameter, right atrial diameter,right ventricular diameter and right atrial enlargement in the TTE.4. ASD patients with PAH in adults dominated higher mean right ventricular pressure, mean right atrial pressure and Qp/Qs ratio in hemodynamics.5. Age, ASD diameter and MPV level were independent risk factors for the occurrence of PAH in adult patients with ASD.