国产蘑菇伞介入治疗成人动脉导管未闭合并肺动脉高压的临床疗效研究

Catheter closure of patent ductus arteriosus with pulmonary hypertension by domestic-made mushroom occluder in adults

目的：评价国产蘑菇伞经导管介入治疗成人动脉导管未闭（PDA）合并肺动脉高压的临床疗效．方法：选择2002—12／2007—12我科对成人PDA合并肺动脉高压98（男32，女66）例实施经导管介入治疗的患者；年龄18～65（37．8±12．6）岁；体质量43.8—68.5（54.04-8．3）kg；行右心导管检查测定肺动脉压力、主动脉压力，行主动脉弓降部造影，确定PDA位置、形状及大小，PDA最窄处内径4．5—18．2（7．8±6．9）mm．以国产蘑菇伞堵闭器行介入治疗，根据封堵实验决定能否行永久封堵．术后24h，1，3，6和12mo行彩色多普勒超声心动图检查．结果：4例封堵后30min肺动脉收缩压无下降，反而有轻度上升，考虑为阻力性重度肺动脉高压，撤出封堵器．余94例术后30min肺动脉压收缩压由术前（68．2±26．6）mmHg（1mmHg=0．133kPa）降为（41．8±18．4mmHg（P〈0．05），肺动脉平均压降由术前（46．2±16．5）mmHg降为（28．2±10．7）mmHg（P〈0．05），主动脉压由术前（102．2±12．7）mmHg变化至（108．6±14．8）mmHg（P〉0．05）．术后30min主动脉弓降部造影显示，72例（76．6％）封堵完全，22例（23．4％）可见极少量残余分流，术后24h心脏彩超复查90例（95．7％）封堵完全，4例（4．3％）有少量残余分流，术后1mo彩超复查皆无残余分流；无再通和堵闭器移位等并发症发生，结论：在阻力性重度肺动脉高压发生前应用国产蘑菇伞经导管封堵治疗成人PDA合并肺动脉高压是一种安全、简便、有效、创伤小、恢复快的方法，值得推广应用．

AIM： To evaluate the treatment efficiency of catheter closure of patent ductus arteriosus （PDA） with pulmonary hypertension by domestic-made mushrooms occluder in adults. METHODS： Ninety-eight cases of adult PDA （32 males and 66 females） underwent attempted catheter closure by using domesticmade mushroom shape occluder at the median age of patients （37.8 ± 12.6） years（ranging 18 to 65 years） and the mean weight was （54.0 ±8.3） kg（ranging from 43.8 to 68.5 kg）. Pulmonary arterial pressure, aortic pressure and oxygen saturation were measured. The mean PDA diameter of narrowest segment was （7.8 ±6.9） mm（ranging from 4.5 to 18.2 mm） by aortography. The achievement of permanent transcatheter closure was decided according to the change of the pulmonary arterial pressure, aortic pressure and oxygen saturation. The lateral descending aortographies were performed to evaluate the immediate results 30 min after the procedure. Follow-up evaluation was performed with color flow mapping at 24 h, 1,3,6 mo and 1 year after closure respectively. RESULTS： The devices were successfully placed in all patients except 4 patients owing to obstructive pulmonary hypertension. The systolic pulmonary pressure decreased from （68.2±26.6） to （41.8±18.4） mmHg（P〈0.05）, the mean pulmonary pressure from （46.2 ± 16.5 ） mmHg to （28.2 ± 10.7） mmHg（P 〈 0.05）, and aortic pressure varied from （102.2 ±12.7） to （108.6±14.8） mmHg（P〉0.05） 30 min after the device deployment in the rest 94 cases. Complete anglographic closure was seen 30 min after the device deployment in 72 out of 94 patients（72.6% ） ,while small leaks were presented in 22 cases（23.4% ）. Complete echocardiographic closurewere demonstrated in 90 out of 94 patients（95.7% ） within 24 h and 100% at 1-month follow-up in all patients. There was no PDA recanalization and migration of devices and other complications after the complete occlusion during 1-12 mo following up. CONCLUSION ： Catheter closure of adult PDA with pulmonary hypertension using the domestic-made mushroom shape occluder is a safe and effective interventional therapy before the occurrence of obstructive pulmonary hypertension.