动脉导管未闭封堵术后早期心血管超声改变研究

Premature cardiovascular ultrasonographic variations after transcatheter closure in patients with patent ductus arteriosus

目的观察动脉导管未闭(PDA)封堵术后1周患者心血管系统超声变化,探讨其临床意义。方法收集2008—2010年中国医科大学附属第一医院行内科PDA经导管封堵术患者40例,根据术前左室舒张期末内径(LVDD)分为A组(LVDD≥55 mm)、B组(LVDD<55 mm);根据术前肺动脉平均压(PAMP)分为Ⅰ组(PAMP<25 mmHg)、Ⅱ组(25 mmHg≤PAMP<50 mmHg)、Ⅲ组(PAMP≥50 mmHg)。对比研究其术前和术后1周经胸超声心动图(TTE)变化。结果 (1)术后升主动脉内径/肺动脉内径比值由1.11±0.22增至1.21±0.25(P=0.0231);术后主动脉瓣流速由(1.77±0.69)m/s减至(1.46±0.54)m/s(P=0.0467),左房内径由(40.13±6.44)mm减至(36.05±6.28)mm(P=0.0027),LVDD由(59.58±10.20)mm减至(54.40±9.19)mm(P=0.0098)。(2)LVDD不同患者术后1周左心房、左心室均明显缩小,差异有统计学意义。LVDD较大组差异更显著。(3)PAMP不同患者术后1周左心房、左心室均明显缩小,Ⅰ组差异有统计学意义,Ⅱ组差异有统计学意义,Ⅲ组差异无统计学意义。结论能耐受PDA封堵术的患者均能在术后早期开始获益,术前LVDD较大组和PAMP<25 mmHg组获益最大。

Objective To investigate variation in transthoracic echocardiography （TIE） of cardiovascular system a week af- ter transcatheter closure in patients with patent ductus arteriosus （PDA） and explore the clinical significance. Methods A total of 40 patients with PDA were enrolled from The First Affiliated Hospital of China Medical University between 2008 and 2010 to receive transeatheter arterial closure surgery. Based on preoperative left ventricular diastolic diameter （LVDD）, subjects were allocated into group A （ I〉55 ram） and group B （ 〈 55 ram）. Additionally ,according to preoperative pulmo- nary artery mean pressure （PAMP） , subject were further divided into group Ⅰ （ 〈 25 mmHg） , group Ⅱ （ 25 mmHg ≤ PAMP 〈50 mmHg） and group 111 （ ≥50 mmHg）,respectively. The variation in TIE prior to transcatheter closure and 1 week after was compared. Results After transcatheter closure, there was an increase in the ratio of ascending aortic diameter to pulmonary artery diameter （1.11 ±0. 22 vs 1.21 ±0.25 ,P = 0. 0231 ）. A reduction was found in aortic valve blood flow [ （ 1.77±0. 69 ） m/s vs （ 1.46±0. 54 ） m/s, P = 0. 0467 ], left atrial diameter [ （ 40. 13 ± 6. 44 ） mm vs （ 36. 05 ± 6. 28 ）mm,P = 0. 0027 ] and L VDD [ （59. 58 ±10. 20）mm vs （54.40± 9. 19 ）mm,P = 0. 00981. A week after transcatheter closure, there was a marked decline in left atrial diameter and LVDD （ P 〈 0.05 ） , with a larger reduction being revealed in those who had higher LVDD. Furthermore, a significant decrease was found in left atrial diameter and LVDD among sub- groups with various PAMP （ both P 〈 0. 05 ） , with the exception of group Ⅲ（ P 〉 0. 05 ）. Conclusion Transeatheter clo- sure of PDA confers benefits in the early postoperative period in those who could tolerate, in particular, patients with higher LVDD and PAMP 〈 25 mmHg.