动脉导管未闭合并重度肺动脉高压的介入封堵疗效观察

The effect of patent ductus arteriosns with severe pulmonary hypertension with intervention occlusion in clinical treatment

目的评价经导管封堵术治疗动脉导管未闭(PDA)伴重度肺动脉高压的临床疗效与安全性。方法选择2006年1月至2010年2月在遵义医学院附属医院心内科住院并接受经导管封堵治疗的PDA合并肺动脉高压(肺动脉收缩压在80 mmHg或以上、肺动脉平均压在60 mmHg或以上)的病人14例,回顾性分析病人术中及术后随访资料。结果经导管封堵治疗14例PDA合并重度肺动脉高压病人中12例患者获成功(成功率86%)。其中9例病人肺动脉收缩压由85～115(平均100mmHg)降至55～95 mmHg(平均72mmHg),肺动脉平均压由68～92 mmHg(平均78mmHg)降至31～55 mmHg(平均45 mmHg),3例封堵后肺动脉收缩压下降超过20 mmHg,平均压下降超过15mmHg,3d后复查超声提示肺动脉收缩压下降达30 mmHg。2例双向分流病人封堵后压力无下降,其中1例有呼吸困难症状l,例封堵后肺动脉压力较封堵前轻度升高,均放弃封堵。结论动脉导管未闭伴重度肺动脉高压病人行介入封堵时,在严格掌握封堵指征的情况下,封堵是安全有效的。对于双向分流者,观察指标的要求应更加严格,封堵治疗应更加慎重。

Objective To evaluate the clinical curative effect and the safety of transcatheter closure patent ductus arteriosus（PDA） with severe pulmonary hypertension.Methods Nineteen patients of PDA with systolic pulmonary pressure more than 80mmHg and mean pulmonary pressure more than 60mmHga,ged（16±10）Y,accepted transcatheter closure and analysis were performed retrospectively.Results 12/14 cases were successfully occluded,with all achievement rate of 85%.In the 9 cases,the systolic pulmonary pressure decreased from85～115（mean100）mmHg to 55～95（mean72）mmHg,the mean pulmonary pressure from68 ～92（mean78）mmHg to 31 ～55（mean45）mmHg.Systolic pulmonary pressure after transcatheter closure decreased by more than 20 mmHg and the mean pulmonary pressure decreased by more than 15mmHg in the other 3 cases.Systolic pulmonary pressure drop 30mmHg after 3 day by the echocardiographic demonstrate.The rest two two-way shunt cases showed that no significant decrease in pulmonary pressure after transcatheter closure,One patient appeared severe breathing difficulties,another the pulmonary pressure increased slightly after transcatheter closure,then both to quit the closure.Conclusions Catheter closure of PDA with severe pulmonary hypertension is a safe and effective interventional therapy under the strict control indications of the transcatheter closure.For two-way shunt,the requirements of observation standards should be more strictly and the closure should be more careful.