重度肺动脉高压伴左室内径正常动脉导管未闭的临床特点和介入治疗  

Clinical Manifestation and Transcatheter Occlusion of Patent Ductus Arteriosus Associated with Severe Pulmonary Arterial Hypertension with Normal Internal Diameter of Left Ventricle

作　　者：李传昶[1] 谢启应[1] 蒲晓群[1] 陈晓彬[1] 杨天伦[1] 邓金华[1] 孟霜媛[1] 

机构地区：[1]中南大学湘雅医院心内科,湖南长沙410008

出　　处：《实用预防医学》2009年第4期1178-1180,共3页Practical Preventive Medicine

摘　　要：目的总结伴重度肺动脉高压,而左心室内径正常的动脉导管未闭(PDA)患者的临床特点和经导管介入封堵治疗疗效。方法采用经胸心脏超声和主动脉降部造影诊断6例表现为右房右室显著扩大,而左心室内径正常的重度肺动脉高压PDA患者,明确诊断后行经皮介入封堵治疗,术后行经胸心脏超声随访。结果4例患者经胸心脏超声,2例经主动脉降部造影检查明确诊断。所有患者经胸超声表现为右房、右室和肺动脉内径显著增宽,重度肺动脉高压,左心室内径正常。4例经皮介入封堵成功,其中3例试封堵后肺动脉压明显下降,1例试封堵后肺动脉压下降不明显,随访中肺动脉压持续下降,但仍未恢复正常。随访中无严重并发症发生,患者临床症状明显改善,心功能改善。结论对于表现为右心显著扩大,左室内径正常的重度肺动脉高压PDA患者经胸超声胸骨旁高位动脉导管切面有助于提高诊断率。介入封堵治疗对部分患者切实、可行,近期效果好。Objective To explore the clinical manifestation and effectiveness of transcatheter closure of patent ductus arteriosus （PDA） associated with severe pulmonary arterial hypertension with normal internal diameter of left ventricle. Methods Transthoracic ultrasonic echocardiogram and aortic angiography were applied in all patients. Transcatheter closure of PDA was performed and followed up by transthoracic ultrasonic echocardiogram after successful treatment. Results Six patients （2 men and 4 women） suffered from PDA with normal internal diameter of left ventricle were enrolled in this study; among them, 4 patients were diagnosed by transthoracic ultrasonic echocardiogram and 2 patients by aortic angiography. All patients associated with severe pulmonary arterial hypertension and enlarged dimension of right atrium, right ventricle and pulmonary artery and normal internal diameter of left ventricle. 4 of the 6 patients successfully occluded with PDA occluder and 2 patients failed, tn 3 patients with successful occlusion, mean pulmonary arterial pressures decreased significantly after trial occlusion. The occlusion Was not successful in 1 patient, because patient showed worsening of symptoms. And pulmonary arterial pressures increased after trial occlusion. In patients with successful occlusion, the dimensions of the left atrium, left ventricle and pulmonary artery decreased considerably in follow - up compared with those of pre - occlusion. Conclusions Parasternal superior position cross 7 section in transthoracic ultrasonic echocardiogram may improve diagnosis of patients with PDA associated with severe pulmonary arterial hypertension with normal internal diameter of left ventricle, and transcatheter closure may be feasible and effective in treating partial patients.

关 键 词：动脉导管未闭 肺动脉高压 左室内径正常 介入封堵 

分 类 号：R543.2[医药卫生—心血管疾病]