成人并发重度肺动脉高压动脉导管未闭介入治疗及近期预后  

Transcatheter closure of patent ductus arteriosus complicated severe pulmonary arterial hypertension in adults

作　　者：谢启应[1] 蒲晓群[1] 杨天伦[1] 李传昶[1] 陈晓彬[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：《中国内镜杂志》2010年第2期154-157,共4页China Journal of Endoscopy

摘　　要：目的总结成人并发重度肺动脉高压动脉导管未闭(PDA)患者的介入治疗可行性和近期预后。方法 22例年龄18～47(27.6±8.8)岁并发重度肺动脉高压的成年PDA患者根据心脏超声改变分为3组:A组(11例):左室扩大,右室内径正常;B组(6例):左室、右室均扩大;C组(5例),右室扩大,但左室内径正常。封堵前测量肺动脉压,应用国产PDA或房间隔缺损(ASD)封堵伞进行封堵,术后采用经胸超声心动图随访。结果各组术前肺动脉压均重度增高,A组肺动脉压较B组和C组低,但差异无显著性(P>0.05)。A组11例均采用国产PDA封堵伞即刻封堵成功。B组5例即刻封堵成功,3例使用国产PDA封堵伞,2例分别使用22和24mm国产ASD封堵伞;1例试封堵后肺动脉上升,主动脉压下降,放弃封堵。C组4例封堵成功,均使用国产PDA封堵器。1例家属和患者放弃手术。各组患者成功封堵后肺动脉压有不同程度的下降,但C组下降程度不如其他两组(P<0.05)。介入封堵成功患者随访1～58个月,平均(23.2±24.6)个月。A组1例患者术后出现较大残余分流转外科手术,其余患者均无残余分流和发生严重并发症。与术前相比,左室、左房较术前不同程度缩小;B组和C组病例增厚的右室前壁变薄,右室、右房、肺动脉内径缩小,三尖瓣、肺动脉瓣返流减轻。结论介入封堵可安全有效治疗大部分并发重度肺动脉高压的成人PDA,近期疗效好。【Objective】To evaluate the effectiveness of transcatheter closure of patent ductus arteriosus （PDA） with severe pulmonary arterial hypertension （PH） in adults.【Methods】22 adult patients,aged 18～47 （27.6 ± 8.8）,complicated severe PH were divided into three groups.Group A： suffered for PDA with enlarged left ventricle;Group B： suffered for PDA with enlarged left and right ventricle;Group C：suffered for PDA with normal left ventricle and enlarged right ventricle.Transcatheter closure of PDA was performed and followed up by ultrasonic echocardiogram after successful treatment.【Results】All patients associated with severe PH,which the systolic pressure higher than 70 mmHg.In group A,11 patients successfully occluded with PDA occluder.In group B,5 out 6 patients performed successful transcatheter occlusion,3 patients with PDA occluder and 2 patients with ASD occluder.In group C,4 out 5 patients performed successful occlusion with PDA occluder.Pulmonary arterial pressures gravitated markedly after occlusion,as compared with group C,the decrease was more extensive in group A and B [（53.8 ±10.7） vs （85.0±26.0） mmHg,（54.0±9.9） vs （85.0±26.0） mmHg,respectively,P〈0.05].Patients that successfully occluded followed up for 1～58 （23.2±24.6） months.One patient in group A received surgical operation for obviously residual shunt.In patients with successful occlusion,the dimensions of the left atrium,left ventricle,right ventricle and pulmonary artery attenuated considerably in follow -up compared with those of preocclusion.【Conclusions】Tran-scatheter occlusion of PDA complicated reversible severe pulmonary arterial hypertension in adults is effective and show good short-term results in most patients.

关 键 词：动脉导管未闭 重度肺动脉高压 封堵 

分 类 号：R814.47[医药卫生—影像医学与核医学]