巨大型动脉导管未闭合并重度肺动脉高压患者的介入治疗及随访  

Treatment and follow-up in patients with large patent ductus arteriosus complicated with severe pulmonary hypertension treated by transcatheter occlusion

作　　者：刘卫其[1] 张励庭[1] 吴惠玉[1] 叶木奇[1] 刘少中[1] 

机构地区：[1]广东省中山市人民医院心血管内科,广东中山528403

出　　处：《岭南心血管病杂志》2011年第5期364-367,共4页South China Journal of Cardiovascular Diseases

基　　金：中山市科技计划项目(项目编号:20071A048)

摘　　要：目的评价经导管封堵治疗巨大型动脉导管未闭(patent ductus arteriosus,PDA)合并重度肺动脉高压(pulmonary hypertension,PH)患者的疗效及安全性。方法应用蘑菇伞PDA封堵器对18例巨大型PDA合并重度PH的患者进行试封堵,封堵成功后进行定期临床随访。随访内容包括临床症状、心功能情况、肺动脉压力变化。患者于术后1 d,1、3、6、12个月以及每年复查X线胸片、心电图和超声心动图。结果 18例患者中,12例巨大型PDA均封堵成功,6例未能成功封堵。成功封堵的12例患者的PDA最小直径为(14.4±2.7)mm,所选择的蘑菇伞PDA封堵器肺动脉端直径为(15.7±3.9)mm;封堵前后肺动脉收缩压由(90.2±17.7)mm Hg(1 mm Hg=0.133 kPa)降至(45.4±13.8)mm Hg,差异有统计学意义(P<0.001);封堵前后主动脉压力变化差异无统计学意义[(123.3±14.3)/(72.6±8.7)mm Hg vs.(124.0±14.5)/(74±8.0)mm Hg,P>0.05];封堵后的外周血氧饱和度较封堵前略有升高,但差异无统计学意义(98.30%±1.00%vs.96.80%±1.38%,P>0.05)。术后第1天复查超声心动图,结果提示6例左心室、左心房和主肺动脉直径明显缩小,3例左心室、左心房直径明显缩小,其余3例左心室、左心房和主肺动脉直径无明显改变,其中有3例可见残余少量分流;X线胸片提示肺充血情况均有所减轻。术后随访1～3年,全部患者无胸闷、气促发作,复查超声心动图提示无或仅有少量残余分流。6例未能成功封堵的患者,其中3例为双向分流,临床可见分界性发绀,试封堵时肺动脉压无明显下降或升高;3例试封堵后有大量残余分流。结论经导管封堵治疗巨大型PDA合并重度PH患者是可行的,短、中期疗效理想,远期疗效尚需观察;术中试封堵时必须严密监测患者症状、血氧饱和度以及肺动脉、主动脉压力。Objectives To evaluate the effect and safety in patients with large patent ductus arteriosus （PDA） complicated with severe pulmonary hypertension （SPH） treated by transcatheter occlusion. Methods Eighteen patients with large PDA complicated with SPH underwent transcatheter closure. Clinical follow-up including symptoms, heart function and change of pulmonary hypertension were observed regularily.Chest X-ray, electrocardiogram and eehocardiography （UCG） were performed respectively in one day, one month, three months, six months and twelve months post transcatheter closure. Results Twelve out of 18 patients had successful occlusion. The minorest diameter of PDA was（14.4＋2.7） ram, and the diameter of selected oecluder was （15.7±3.9） mm. Systolic pulmonary arterial pressure decreased significantly after trial occlusion [（90.2±17.7） mm Hg vs. （45.4±13.8） mm Hg,P〈0.001; 1 mm Hg=0.133 kPa）. No significant change occurred in arterial pressure before and after occlusion[ （123.3±14.3）/（72.6±8.7）mm Hg vs. （124.0±14.5）/ （74.0 ±8.0）mm Hg,P〉0.05]. No significant change occured in systemic artery oxygen saturation before and after occlusion （96.80%±1.38% vs. 98.30%± 1.00%, P〉0.05）. Repeated UCG showed that the dimensions of left atrium, left ventricle and pulmonary artery significantly attenuated in 6 patients the day after procedure. UCG showed that diameter of left atrium, left ventricle significantly attenuated in 3 patients, and the other 3 patients have no significant change in the dimensions of left atrium, left ventricle and pulmonary artery.Small residual shunt occured in 3 patients. Besides, X rays showed that pulmonary vascularity decreased in the 12 patients mentioned above. All the patients were followed up for 1 to 3 years who were free of symptoms like chest pain and short of breath. And UCG showed that they were without or with small residual shunt. Six patients had unsuccessful occlusion, three of which have bilaterral shunt with differential cya

关 键 词：动脉导管未闭 肺动脉高压 经导管封堵 随访 

分 类 号：R541.1[医药卫生—心血管疾病]