不同海拔动脉导管未闭患者经皮封堵术的超声心动图评价

Echocardiographic assessment of patients with patent ductus arterious living in regions of different altitude after being treated with transcatheter obliteration

目的探讨经胸超声心动图（TTE）对不同海拔地区动脉导管未闭（PDA）经皮封堵术的评价作用。方法选择2009年1月-2012年8月在武警总医院接受经皮封堵治疗的PDA患者353例，其中115例居住在高海拔地区（3600m以上）．238例在低海拔地区（800m以下）。应用Vivid7N声诊断仪行TTE检查，观察PDA形态、直径和长度。封堵术后第3-5天及3、6、12个月复查TTE，评价封堵术的疗效。结果术前检查30例有合并畸形（8．5％）。346例患者经导管封堵治疗获得成功，成功率为98．0％；术后3—5d左室内径缩小，射血分数（LVEF）减低，与术前比较差异均有统计学意义（P〈0．05）。高海拔组术前与术后LVEF差值明显大于低海拔组（6．8％±6．7％ vs 52．0％±4．5％，P〈0．05）。19例LVEF减至50％以下，其中高海拔组14例，低海拔组5例。肺动脉收缩压〉70mmHg的36例中，32例完成封堵术，且术后肺动脉收缩压下降均大T30mmHg。13例可见残余分流，1例行外科取伞，7N3个月后残余分流消失。12例封堵伞较大，超过降主动脉内径50％，其中1例出现降主动脉血流速度增快。结论超声心动图在不同海拔地区PDA患者的经导管封堵术前筛查、疗效评价及随访中具有重要作用。

Objective To evaluate the practical value of transthoracic echocardiography （TTE） in transcatheter treatment in patients with patent ductus arterious （PDA） living in regions of different altitude. Methods Three hundred and fifty-three patients with PDA who had undergone TTE examination were divided into two groups, 115 patients in high altitude group （living in regions higher than 3600m） and 238 patients in low altitude group （living in regions lower than 800m）. The pattern, diameter and length of PDA were determined by TTE （Vivid 7）, and the therapeutic effect was assessed 3-5 days, and 3, 6 and 12 months after closure. Results Thirty patients were found to have other congenital heart diseases. Transcatheter closure was successful in 346 patients, and the success rate of operation was 98.0%. Compared with that before operation, the left ventricular diameter and left ventricular ejection fraction （LVEF） were decreased significantly after closure （P〈0.05）. The LVEF in 19 patients was decreased to less than 50%, including 14 patients living in high altitude regions and 5 patients living in low altitude regions. Of 36 patients whose systolic pulmonary pressure was over 70mmHg, 32 underwent closure successfully and their systolic pulmonary pressure decreased more than 30mmHg after operation. Residual shunt was found in 13 patients. Out of these patients, the occluder was removed in 1 by surgery, and the residual shunt disappeared in 7 patients 3 months later. The occluders in 12 patients were larger than 50% of the diameter of descending aorta. Increased flow rate in the descending aorta was found in one of the 12 patients. Conclusion Echocardiography is a valuable method in screening the PDA patients living in regions of different altitude before transcatheter therapy, and also for evaluating the therapeutic effects after the operation.