中老年动脉导管未闭患者介入治疗139例分析

Effects of transcatheter closure of patent ductus arteriosus in 139 adult patients

目的分析中老年动脉导管未闭（PDA）患者的临床特征及探讨行经导管封堵治疗的安全性。方法选择2000年1月至2009年4月在我科介入治疗的139例40岁以上PDA患者，男22例，女117例，年龄40～74（49．8±6．8）岁，术前心功能分级为Ⅰ级64例，Ⅱ级53例，Ⅲ级16例，Ⅳ级6例，分析中老年PDA患者临床特征及观察封堵PDA前后肺动脉压和心功能的改善情况。结果139例患者中合并肺动脉高压107例，发生率为77．0％，3例严重肺动脉高压者不适宜手术治疗，其余136例均成功行介入治疗，成功率为97．8％。封堵PDA后主动脉造影显示残余分流微母14例，少量2例，中等量分流1例，无手术相关并发症。术后心功能显著改善，肺动脉收缩压由术前（47．3±23．9）mmHg（1mmHg=0．133kPa）降至（28．1±12．3）mmHg，肺动脉平均压由（31．7±17．4）mmHg降至（17．9±8．8）mmHg（均P〈0．01）。结论中老年PDA患者肺动脉高压发生率高，心功能差，经导管封堵中老年PDA是一种安全有效的方法。

Objective To analyze the clinical feature and the effects of transcatheter closure of adult patients with patent ductus arteriosus （PDA）. Methods Between January 2000 and April 2009, 139 patients [ 22 male, aged from 40 to 74 ： （ 49. 8 ± 6. 8 ） years ] with PDA were hospitalized in our hospital. Clinical data and effects of transcatheter closure of PDA were analyzed. Results There were 64 patients with NYHA class Ⅰ , 53 with class Ⅱ , 16 with class Ⅲ and 6 with class Ⅳ before procedure. In 139 patients, pulmonary arterial hypertension （PAH） was found in 107 out of 139 patients （77.0%）. Transcatheter PDA closure was not performed in 3 patients due to severe PAH and successfully performed in the remaining 136 patients （97.8%） without major complications. Post procedure aortic angiography evidenced minor residual shunt in 14 cases, small residual shunt in 2 cases and moderate shunt in 1 case. The NYHA class was significantly improved and the PAH significantly reduced [ sPAP： （47.3 ± 23.9） mm Hg （ 1 mm Hg = 0. 133 kPa） vs. （28. 1 ± 12. 3） mm Hg,P 〈 0.01 ] post procedure. Conclusion PAH and heart failure were commonly associated with PDA in adult patients. Transeatheter PDA closure is safe and effective in these patients except those with severe PAH.