覆膜支架在成人动脉导管未闭合并肺动脉高压的临床应用  

Closure of large patent ductus arteriosus with pulmonary hypextension in adults with stent-graft

作　　者：李进华[1] 来永强[1] 许尚栋[1] 李景伟[1] 赖以恒[1] 崔永超[1] 郝兴海[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2009年第5期309-311,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结覆膜支架治疗成人动脉导管未闭合并肺动脉高压的体会。方法2005年9月至2007年3月，4例成人动脉导管未闭合并肺动脉高压病例应用覆膜支架封堵，均为女性，年龄18～42岁，平均（31．5±5．4）岁。动脉导管平均直径（28．3±0．8）mm，肺动脉收缩压平均（66．0±8．3）mmHg。术后随访3。18个月，平均（10．5±1．5）个月。结果术后造影示3例动脉导管完全封闭，1例残余少量左向右分流。术后2周超声心动及大血管CT示残余分流消失，肺动脉收缩压平均（40．5±7．5）mmHg。4例术后平稳，临床症状缓解。结论覆膜支架治疗成人动脉导管未闭合并肺动脉高压近期效果良好，是一种可选择的治疗方法。Objective Patent ductus artefiosus （PDA） is one of the most common congenital heart defects. Because of the fragility of the aorta, surgical closure of PDA carries a higher risk in adults. Our preliminary experience of using stent-graft to close large PDA in adults was reported. Methods From Sept. 2005 to Mar. 2007, four adult patients with large PDA and pulmonary hypertension underwent stent-graft implantation. All patients were female. The average age was （31.5 ± 5.4） years （ranging from 18 years to 42 years）. The average diameter of PDA was （28.3 ± 0.8） mm with main pulmonary artery pressure of （66.0± 8.3） mm Hg. All patients were followed from 3 to 18 months （average 10.5 months）. The clinical data were analyzed. Results Completely occlusion of PDA was achieved in 3 cases immediately after stent-graft implantation. Trivial left to right shunt remained in 1 case. It disappeared two weeks later by tests of echocardiography and CT examination. Mean pulmonary artery pressure decreased （40.5 ± 7.5） mm Hg. Postoperative course was uneventful and symptoms disappeared during the follow-up period. Conclusion Early results of endovascular repair of PDA with stent-graft are encouraging. Stent-graft implantation may be a therapeutic alternative for certain adult patients with a large PDA with pulmonary hypertension.

关 键 词：动脉导管未闭 支架 心脏外科手术 肺动脉高压 

分 类 号：R686[医药卫生—骨科学]