成人动脉导管未闭伴重度肺动脉高压患者血流动力学特点及介入治疗评价

Clinical characteristics and evaluation of interventional treatment of patent ductus arteriosus with severe pulmonary arterial hypertension in adults

目的:分析成人动脉导管未闭(PDA)伴重度肺动脉高压(PAH)患者的血流动力学特点,评价其经导管封堵治疗的可行性。方法:21例成人PDA伴重度PAH患者为治疗组,对照组65例(其中轻中度PAH组28例,无PAH组37例)。术后采用心电图及经胸超声心动图(TTE)随访。结果:与对照组相比,治疗组的全肺阻力(TVR)显著增加(P<0.05),而QP/Qs无明显差异(P>0.05);治疗组PDA直径显著高于对照组(P<0.01);治疗组中,TVR>5.6Wood者占52.4%,肺动脉收缩压与体动脉收缩压之比>0.75者占52.4%,肺动脉收缩压高于2/3体动脉收缩压者占61.9%,Qp/Qs<1.5者占9.5%;治疗组中,封堵后平均肺动脉压较封堵前明显下降[(43.95±15.56)mmHg∶(76.48±17.09)mmHg,1mmHg=0.133kPa,P<0.01],肺动脉收缩压较封堵前明显下降[(67.05±21.56)mmHg∶(101.65±22.80)mmHg,P<0.01],主动脉收缩压较封堵前明显上升[(140.25±22.11)mmHg∶(117.70±16.23)mmHg,P<0.05],封堵后TTE测量主肺动脉内径较封堵前明显缩小[(33.65±8.21)mm∶(41.47±8.51)mm,P<0.05]。结论:成人PDA伴重度PAH患者肺血管阻力显著增加,但在严格掌握介入适应证前提下,经导管封堵治疗安全、可行。

Objective：To analyze the clinical characteristics and hemodynamic characteristics of patent ductus arteriosus （PDA） with severe pulmonary arterial hypertension in adulthood, and to evaluate the feasibility of transcatheter closure. Method： All 21 grown-up cases with PDA and severe PAH were enrolled as treatment group, 28 grown-up cases with PDA and mild to moderate PAH and 37 grown-up PDA cases with non PAH were enrolled as control group. Electrocardiograms and echocardiograms were used for follow-up after operation. Result：Compared with control group, total vascular resistance （TVR） was significantly increased in treatment group （P（0.05）, but there was no significant difference in the ratio of pulmonary blood flow （QP） and systemic blood flow （QS） （QP ： QS） （P〉0.05）. The PDA diameter in treatment group was significantly longer than that in control group （P（0.01）. In treatment group, the ratio TVR〉5.6 Wood was 52.4%, ratio of pulmonary artery systolic pressure and systemic arterial pressure 〉0.75 was 52.4%, pulmonary artery systolic pressure higher than 2/3 of sys temic arterial pressure was 61.9%, and the ratio of QP ： QS〈1. 5 was 9.5%. In treatment group, mean pulmonary artery pressure of post-operation was significantly lower than pre-operation [（43.95 ± 15.56）mmHg ： （76.48 ± 17.09）mmHg, P〈0.01] and pulmonary artery systolic pressure of post-operation was significantly decreased compared to pre operation [（67.05±21.56）mmHg ： （101.65±22.80）mmHg, P〈0.01], aortic systolic blood pressure was significantly increased compared to pre-operation [（140.25±22.11） ： （117. 704±16.23）mmHg, P〈0.05], and then, pulmonary artery diameter after closure measured by transthoracic eehocardiography was signifi- cantly smaller than before [（33.65±8.21）mm ： （41.47±8.51）mm, P〈0.05]. Conclusion： Pulmonary vascular resistance of the grown-up patients with PDA and severe PAH is significantly increased, but the transcatheter closure is safe and feasible under strictly selecting cases according to the indications for interventional treatment.