带孔房间隔缺损封堵器治疗房间隔缺损合并重度肺动脉高压的疗效观察  

Curative effect of fenestrated occluders in atrial septal defects with severe pulmonary arterial hypertension

作　　者：陈火元[1] 朱鲜阳[1] 盛晓棠[1] 张端珍[1] 王琦光[1] 韩秀敏[1] 崔春生[1] 庚靖淞[1] 

机构地区：[1]沈阳军区总医院全军心血管病研究所先心病内科,辽宁沈阳110016

出　　处：《中国介入心脏病学杂志》2015年第11期601-605,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的评价带孔（8 mm）房间隔缺损封堵器（ASO）治疗房间隔缺损（ASD）合并重度肺动脉高压（PAH）的疗效。方法选取沈阳军区总医院2002年9月至2013年4月收治的17例（男1例,女16例）ASD合并重度PAH患者,采用带孔ASO行介入封堵,术后随访时间为1.5~12（6.4±2.7）年,收集肺动脉压（PAP）、右心室舒张末期内径（RVEDd）、左心室舒张末期内径（LVEDd）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）和左心室射血分数（LVEF）。结果封堵前右心导管检查肺动脉收缩压（s PAP）60~108（88.7±11.7）mm Hg（1 mm Hg=0.133 k Pa）,平均肺动脉压（m PAP）29.3~60（51.0±8.1）mm Hg,肺循环血流量/体循环血流量（Qp/Qs）1.50~2.44（1.8±0.31）,肺血管阻力（PVR）3.1~9.7（5.6±1.5）wood。置入带孔ASO直径为30~42（36±4.9）mm,封堵后s PAP 56~99（70±11.5）mm Hg,m PAP 27~51.7（41.1±7.1）mm Hg,较术前均有显著下降（P〈0.05）。术后3 d和3、6个月RVEDd缩小（P〈0.05）,LVEDd、LVEDV、LVEF均增大（均P〈0.05）。术后3、6个月的s PAP分别为50~78（61.6±7.5）mm Hg和46~68（55.9±5.7）mm Hg,较术前均有显著下降（均P〈0.05）;中远期s PAP为45~100（60.2±13.3）mm Hg,较封堵前显著下降（P〈0.05）,但与术后6个月比较,差异无统计学意义（P〉0.05）。结论采用带孔ASO封堵ASD合并重度PAH效果较好,是治疗ASD合并重度PAH的理想方法。Objective To evaluate clinical effectiveness of transcatheter closure of atrial septal defects（ ASD） with severe pulmonary arterial hyperyension（ s PAH） by fenestrated Amplatzer septal occluders（ ASO）. Methods From September 2002 to April 2013,17 patients of ASD with s PAH received transcatheter ASD closure using fenestrated occluders. Aged from 18- 72 years,the diameters of ASDs were 18- 33 mm. The systolic pulmonary arterial hypertension measured by transthoracic echocardiogram were 80- 112（ 96. 9 ± 8. 9） mm Hg. The follow-up study included electrocardiography,chest radiography and echocardiography. All the patients were followed up for 1. 5- 12（ mean 6. 4 ±0. 7） years. Results Systolic pulmonary arterial pressure（ s PAP） of 60- 108（ 88. 7 ± 11. 7） mm Hg and mean pulmonary artery pressure（ m PAP） of 29. 3- 60（ 51. 0 ± 8. 1） mm Hg were measured by cardiac catheterization before ASD closure. Qp / Qs was 1. 50- 2. 44（ 1. 8 ± 0. 31） and the pulmonary vascular resistance was 3. 1- 9. 7（ 5. 6 ± 1. 5） wood units（ wu）. Immediately after the implantation of fenestrated occluders,s PAP decreased to 56- 99（ 70 ± 11. 5） mm Hg and m PAP to 27- 51. 7（ 41. 1 ± 7. 1） mm Hg.On the 3 d,3 m and 6 m follow-up exam,RVEDd decreased（ P〈0. 05）,while LVEDd,LVEDV and LVEF increased significantly（ P〈0. 05）. s PAP decreased significantly after transcatheter closure at 3 m and 6 m as compared to pre-closure levels（ both P〈0. 05）. The mean s PAP in long term follow up was（ 60. 2 ± 13. 3） mm Hg which had significant decrease compared to pre-closure level（ P〈0. 01）,but no significant difference found when compared to 6 m follow up（ P〈0. 05）. Conclusions ASD closure with fenestrated ASO is a satisfactory approach for ASD with severe PAH.

关 键 词：先天性心脏病 房间隔缺损 肺动脉高压 带孔房间隔缺损封堵器 

分 类 号：R541.1[医药卫生—心血管疾病]