合并重度肺动脉高压的房间隔缺损的封堵试验

Clinical role of experimental transcatheter occlusion of atrial septal defect complicated with severe pulmonary hypertension

目的应用国产封堵器试验性封堵房间隔缺损(ASA),评价其在ASA合并重度肺动脉高压(SPH)患者封堵治疗中的临床价值。方法对12(男8,女4)例ASA合并SPH患者实施封堵器堵塞ASA试验,观察肺动脉收缩压、肺动脉平均压有无降低及血氧饱和度变化,以此分析肺血管病变是否可逆。结果12例重度肺动脉高压者,肺动脉收缩压10.9～19.3(12.7±5.2)kPa,平均压为7.0～13.1(9.4±2.6)kPa,其中4例血氧饱和度小于90%。9例试封堵术后30min～1h肺动脉收缩压降至5.8～13.4(7.4±3.8)kPa,肺动脉平均压降至2.4～8.1(4.3±2.9)kPa,遂行永久性封堵治疗。3例肺动脉压和动脉血氧饱和度无明显变化,为阻力性肺动脉高压,不宜进行封堵治疗。结论对于ASA伴严重肺动脉高压者,封堵关闭ASA试验是鉴别肺动脉高压是否为阻力性肺动脉高压的安全有效的方法,在封堵治疗ASA合并重度肺动脉高压(SPH)的病例选择中有重要的临床价值。

Objective To evaluate the clinical value of closure of atrial septal defect （ASD） in the patients with severe pulmonary hypertension （SPH） by applying the domestic occlusion device experimentally. Methods 12 cases of ASD associated with SPH were selected to attend this trial.The domestic occlusion device was used.The trial was to observe whether systolic pulmonary artery pressure （PASP） and mean pulmonary artery pressure （PAMP） decreased and whether oxygen saturation of blood changed. Results In 12 cases with SPH before occlusion,PASP was 10.9 ± 19.3 （12.7 ± 5.27） kPa,PAMP was 7.0 - 13.1 （9.4 ± 2.6） kPa. In 4 cases,oxygen saturation of blood was less than 90%. In 30 - 60 minutes after pursuing to try to occlude ASD,PASP of 9 cases dropped to 5.8 - 13.4 （7.4 ± 3.8） mmHg, their PAMP dropped to 2.4 - 8.1 （4.3 ±2.9） kPa,then occluded permanently for them. But in another 3 cases,pulmonary pressure and oxygen saturation of blood did not change significantly,they were not fit for closure. Conclusion The trial on closure of ASD in those patients with SPH,is a kind of safe and effective method,which differentiates whether pulmonary hypertension is obstructive or not. On selection of cases in pursuing occlusion of ASD in the patients with SPH,the trial has comparatively important clinical value.