经导管封堵治疗动脉导管未闭伴重度肺动脉高压

Treatment of patent ductus arteriosus accompanied with severe pulmonary hypertension with transcatheter occlusion

目的评价经导管封堵术治疗动脉导管未闭伴重度肺动脉高压病人的临床疗效与安全性。方法选择在我院接受经导管封堵术治疗且肺动脉收缩压在80mmHg或以上,肺动脉平均压在60mmHg或以上的动脉导管未闭病人31例,回顾性分析病人术中及术后随访资料。结果31例病人术前肺动脉收缩压80～183(112±28)mmHg,肺动脉平均压63～130(82±22)mmHg。其中30例经导管封堵成功(成功率97%),1例巨大型动脉导管未闭因无合适封堵器而行手术治疗。封堵后10min,26例肺动脉收缩压下降30mmHg以上,2例肺动脉收缩压下降20%以上,另2例肺动脉收缩压无明显改变。1例用房间隔缺损封堵器封堵巨大型动脉导管未闭,在术后3d复查心脏超声时发现封堵器脱入肺动脉而转入外科手术治疗;在5例双向分流者中,1例于术后2个月因重度肺部感染死亡,1例于封堵后血氧饱和度明显增加,但肺动脉压无明显下降,术后2年出现右心功能不全表现。结论动脉导管未闭伴重度肺动脉高压病人,若心脏超声检查示左向右分流,可用经导管封堵术进行根治;但若为双向分流时,经导管封堵治疗应慎重。

Objectives To evaluate the clinical effects and safety on patent ductus arteriosus （PDA） accompanied with severe pulmonary hypertension （SPH） with transcatheter occlusion. Methods Thirty-one patients with systolic pulmonary pressure more than 80 mm Hg and mean pulmonary pressure more than 60 mm Hg, aged （18-＋11）y, accepted transcatheter closure and analyis were performed retrospectively. Results Systolic pulmonary pressures before transcatheter closure were 80-183 （112 ±28） mm Hg, and mean pulmonary pressure, 63-130 （82±22） mmHg. 30/31 cases were successfully occluded, with an achievement rate of 97%. One patient with large PDA accepted surgery operation for no fitting occluder. Domestic PDA occluder were used in 25/30 patients and ASD occluder in 5/30 patients. Systolic pulmonary pressure at 10 min after transcatheter closure decreased by more than 30 mmHg in 26 cases and 2 cases decreased by more than 20%. No significant change in the other 2 cases. All the patients were followed up for 0.5-4 y. One patient with large PDA occluded with ASD occluder accepted surgery operation 3 days after transcatheter closure, because the occluder fell into pulmonary artery. Among 5 patients with bidirectional shunt, one of them died in 2 months after closure, because of severe pulmonary infection. Another one showed better saturation of blood oxygen, but no significant decrease in pulmonary pressure after transcatheter closure, and right heart insufficiency appeared in 2 years after closure. Conclusions PDA patients with SPH should be treated with transcatheter closure which fits shunt from left to right, but should be careful in those with bidirectional shunt.