国产封堵器介入治疗小儿动脉导管未闭并发肺动脉高压的临床疗效  

Transcatheter closure of patent ductus arteriosus with pulmonary hypertension using domestic-made mushroom occluder in children

作　　者：沈桂冬[1] 代政学[1] 樊川民 张玉顺[1] 李寰[1] 郭文怡[1] 王海昌[1] 

机构地区：[1]第四军医大学西京医院心内科,陕西西安710032 [2]咸阳市第二人民医院心内科,陕西咸阳712000

出　　处：《心脏杂志》2008年第3期323-326,共4页Chinese Heart Journal

摘　　要：目的评价国产封堵器经导管介入治疗小儿动脉导管未闭（PDA）并发肺动脉高压的临床疗效。方法回顾分析2003年12月～2007年11月86（男30，女56）例小儿PDA并发肺动脉高压实施经导管介入治疗；年龄8月～12（8±7）岁；体质量11～46（31±8）k；行左、右心导管检查及主动脉弓降部造影，确定PDA位置、形状及大小，PDA最窄处内径4～13（7±5）mm。以国产蘑菇伞堵闭器行介入治疗，根据封堵实验决定能否行永久封堵。术后24h、1个月、3个月、6个月、1年行彩色多普勒超声心动图检查。结果2例（2％）封堵后30min肺动脉收缩压无下降，反而有轻度上升，考虑为阻力性重度肺动脉高压，撤出封堵器。余84例（98％）术后30min肺动脉压收缩压由术前平均（69±24）mmHg（1mmHg=0．133kPa）降为（36±14）mmHg（P〈0．05），肺动脉平均压由术前（45±14）mmHg降为（30±8）mmHg（P〈0．05），主动脉压由术前（94±10）mmHg升至（99±6）mmHg，但无统计学差异。术后30min主动脉弓降部造影显示，18例（21％）可见极少量残余分流，术后24h心脏彩超复查4例（4％）有少量残余分流，术后1月彩超复查皆无残余分流；无严重并发症发生。结论国产蘑菇伞经导管封堵治疗儿童PDA并发肺动脉高压，安全、有效，值得推广应用。AIM To evaluate the efficiency of domestic-made mushroom-shape occluder in children tran- scatheter closure of patent ductus arteriosus （PDA） with pulmonary hypertension. METHODS Eight-six children （30 male and 56 female） with PDA underwent transcatheter closure using domestic-made mush- room-shape oeeluder. The median age of the patients was （8 ± 7） years （ranging from 8 mon to 12 y） and the mean weight was （31±8） kg （ranging fromll kg to 46 kg）. The mean PDA diameter of narrowest segment was （7 ±5） mm （ ranging from 4 mm to 13 mm）. The achievement of permanent transeath- eter closure was decided by the changes of the pulmonary arterial pressure, aortic pressure and oxygen saturation. Follow-up evaluation was performed respectively by color flow mapping at 24 hours, 1 month, 3 months, 6 months and 1 year after closure. The lateral descending aortography was performed to evaluate the immediate results at 30 min after the procedure. RESULTS The devices were successfully deployed in all the patients except 2 patients, owing to obstructive pulmonary hypertension. The systolic pulmonary pressure decreased from （69 ±24） mmHg to （36± 14） mmHg decreased from （45 ±14） mmHg to （30 ±8） mmHg （P 〈 0 （ P 〈 0. 05 ）, the mean pulmonary pressure 05 ）, and aortic pressure increased from （94 ±10） mmHg to （99 ±6） mmHg Complete angiographic closure was found 30 minutes after the device deployment in 66 out of 84 patients （79%）, while small leak was present in 18 patients（21% ）. Complete eehoeardiographie elosure was demonstrated in 80 out of 84 patients （95%） within 24 h and 100% at 1-month follow-up in all the patients. There was no PDA reeanalization and migration of devices after the eomplete oeelusion during 1 - 12 mon following up. CONCLUSION Anterograde transeatheter elosure using the domestic-made mushroom-shape oeeluder is a safe and effective interventional therapy for PDA with pulmonary hypertension in ehildren.

关 键 词：动脉导管未闭 肺动脉高压 介入治疗 封堵器 国产 

分 类 号：R654.2[医药卫生—外科学]