经导管介入封堵治疗儿童动脉导管未闭合并二尖瓣反流疗效评价  

Efficacy evaluation on transcatheter closure of patent ductus arteriosus with mitral regurgitation in children

作　　者：陈艳华 尹丹 郑敏[1] 吕铁伟[1] 易岂建[1] 李谧[1] 向平[1] CHEN Yanhua;YIN Dan;ZHENG Ming;LYU Tiewei;YI Qijian;LI Mi;XIANG Ping(Department of Cardiology,Children’s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院心血管内科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆400014

出　　处：《临床儿科杂志》2022年第7期517-521,共5页Journal of Clinical Pediatrics

基　　金：重庆市科学技术局项目(No.cstc2020jcyj-msxmX0274)。

摘　　要：目的分析单纯经导管介入封堵治疗儿童动脉导管未闭(PDA)合并中、重度二尖瓣反流(MR)的中长期疗效,探究其安全性及可行性。方法回顾2013年3月至2019年3月诊断PDA合并中、重度MR并单纯行经导管介入封堵治疗患儿的临床资料。结果共纳入121例患儿,男27例、女94例,年龄19.8(8.0~28.0)月;合并中度MR 94例,重度MR 27例。超声下PDA直径(6.4±1.8)mm。患儿术前,术后24 h,术后1、3、6、12、24月的主肺动脉(MPA)直径、左心房(LA)直径、左心室舒张末期直径(LVEDD)、左心室收缩末期直径(LVESD)差异均有统计学意义(P<0.05)。与术前相比,术后各随访时间点MPA直径、LA直径、LVEDD和LVESD均缩短,差异有统计学意义(P<0.05)。随访期间120例(93.4%)患儿MR程度较术前减轻。所有患儿术前,术后24 h,术后1、3、6、12及24月的MR面积差异有统计学意义(P<0.05),术后各随访时间点MR面积均较术前缩小,差异有统计学意义(P<0.05),但术后12与24个月之间MR面积差异无统计学意义(P>0.05)。结论PDA合并中、重度MR患儿在严格把握手术指征的前提下,单纯行经导管介入封堵治疗可改善MR程度、降低左心负荷,该方法安全有效。Objective To analyze the medium-and long-term efficacy of simple transcatheter closure in the treatment of children with patent ductus arteriosus(PDA)complicated with moderate and severe mitral regurgitation(MR),and to explore its safety and feasibility.Methods Clinical data of children diagnosed with PDA complicated with moderate and severe MR and treated with transcatheter closure from March 2013 to March 2019 were retrospectively analyzed.Results A total of 121 children(27 boys and 94 girls)with a median age of 19.8(8.0-28.0)months were included.There were 94 cases with moderate MR and 27 cases with severe MR.Echocardiography showed that the diameter of PDA was(6.4±1.8)mm.There were statistically significant differences in the main pulmonary artery(MPA)diameter,left atrium(LA)diameter,left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)among different time points(preoperative,postoperative 24 h,postoperative 1,3,6,12 and 24 months)(P<0.05).Compared with pre-operation,MPA diameter,LA diameter,LVEDD and LVESD were all shortened at each follow-up time point after surgery,with statistical significance(P<0.05).During the follow-up period,120 children(93.4%)had less MR than pre-operation.There were statistically significant differences in MR areas of all children among different time points(preoperative,postoperative 24 h,postoperative 1,3,6,12 and 24 months)(P<0.05).The postoperative MR area at each follow-up time point was significantly smaller than that before surgery(P<0.05),but there was no significant difference in MR area between 12 and 24 months after surgery(P>0.05).Conclusions On the premise of strictly grasping the surgical indications,simple transcatheter closure can improve MR degree and reduce left heart load in PDA combined with moderate and severe MR in children,which is safe and effective.

关 键 词：二尖瓣反流 动脉导管未闭 经导管封堵术 先天性心脏病 

分 类 号：R725.4[医药卫生—儿科]