巨大动脉导管未闭合并肺动脉高压患者介入封堵的可行性和有效性研究  

Safety and efficiency of occluding giant patent ductus arteriosus with severe pulmonary hypertension using occluder

作　　者：郭炜华[1] 史旭波[1] 王国宏[1] 吴明营[1] 陈波[1] 王雷[1] 刘君[1] 陈喆[1] 

机构地区：[1]首都医科大学附属北京同仁医院心脏中心,北京100176

出　　处：《临床荟萃》2011年第17期1473-1475,1479,共4页Clinical Focus

摘　　要：目的应用封堵器治疗巨大动脉导管未闭（PDA）伴重度肺动脉高压（SPH）患者,并评价其临床疗效。方法回顾性分析26例巨大PDA合并SPH患者,应用封堵器封堵PDA,观察封堵前及封堵后肺动脉压力改变,术后随访6个月。结果 23例封堵成功,PDA最窄处直径8－18.0 mm,平均（12.2±4.6）mm。术前肺动脉收缩压为（98.3±23.4）mmHg,平均压为（69.1±15.0）mmHg,封堵后30分钟测肺动脉收缩压为（44.6±10.6）mmHg,平均压为（28.9±7.3）mmHg,较封堵前显著降低（P〈0.01）,3例PDA伴SPH者术中试封堵证实为阻力性肺动脉高压而放弃干预。封堵后30分钟降主动脉造影示22例封堵完全,无残余分流,1例存在中量残余分流。术后24小时超声心动图示1例仍存在微量残余分流,1个月后所有患者均未见残余分流,术后未见溶血、封堵器脱落、移位并发症。结论应用封堵器治疗巨大PDA伴SPH的患者是一种可行的、有效的介入方法。Objective To evaluate the efficiency of transcatheter closure of giant patent ductus arteriosus（PDA） with severe pulmonary hypertension（SPH） using the occluder.Methods 26 patients of giant PDA with SPH were reviewed,they were treated by transcatheter closure with domastic made occluder.Follow-up evaluations were performed with echocardiogram and Doppler at 24 h and 1,3 and 6 months after implantation.Results The devices were successfully placed in 23 patients.The systolic pulmonary pressure decreased from（98.3±23.4） mmHg to（44.6±10.6） mmHg,and the mean pulmonary pressure decreased from（69.1±15.0） mmHg to（28.9±7.3） mmHg（P〈0.05）.The occluder was removed in 3 patients,because of resistant pulmonary hypertension after the experimental closure.Angiographic complete closure was seen in 22 patients,while medium leak was present in 1 patient.Complete echocardiographic closure was demonstrated in all patients after 1 month.Neither displacement of the device,nor hemolysis or left pulmonary stenosis occurred during follow-up.Conclusion Transcatheter closure of PDA with SPH by using domastic made occluder is safe and effective.

关 键 词：动脉导管未闭 高血压 肺性 超声检查 介入性 

分 类 号：R654.24[医药卫生—外科学]