室间隔缺损介入封堵肺动脉压力变化规律的研究

Changes of Pulmonary Artery Pressure after Transcatheter Occlusion of Ventricular Septal Defect

目的探讨成功介入封堵治疗的室间隔缺损(VSD)在封堵前后即刻、随访期间肺动脉压力的变化规律。方法 650例成功施行介入治疗的VSD患者,经导管测定术前及封堵后即刻肺动脉压力,并于介入术前当日,术后3d、1月、3月、6月分别运用超声心动图测定肺动脉压力并进行对比。结果肺动脉收缩压(PASP)和肺动脉平均压(PAMP)超声和心导管测值呈显著正相关。1正常肺动脉压力组:PASP和PAMP在封堵即刻后及随访期间均无统计学意义。2轻度肺高压组:PASP在封堵即刻后无明显变化,6月时与封堵前后比较均显著下降(P<0.05)。PAMP在封堵即刻后升高,术后1月及6月与封堵后比较均显著降低(P<0.05)。3中度肺高压组:PASP及PAMP在封堵即刻后均显著降低(P<0.05),两者在术后3d及随访中与封堵前比较进行性降低(P<0.05);PASP在术后1月、3月、6月较封堵后降低(P<0.05)。结论经导管封堵治疗能明显降低VSD合并轻、中度肺动脉高压患者肺动脉压力,近、中期疗效确切。

Objective To compare the changes of pulmonary artery pressure[systolic pulmonary pressure（PASP）and mean pulmonary pressure（PAMP）]before and after transcatheter occlusion in patients with ventricular septal defect（VSD）.Methods Six hundred and fifty patients with VSD underwent transcatheter closure were involved in this study.The parameters of pulmonary artery pressure including PASP and PAMP were evaluated with cardiac catheter before and after procedures.transthoracic echocardiography examination performed at 3 days after procedures and during follow-up of next six months.Results There was significantly relationship between the pulmonary arterial pressure measured by Doppler echocardiography examination and cardiac catheter examination before transcatheter occlusion in patients with VSD.In normal group,PASP had not significant changes.PAMP increased at 3 months from the operation.In mild pulmonary hypertension group,PASP and PAMP increased immediately after operation,which decreased apparently at 6 months（P〈0.05）.In moderate pulmonary hypertension group,PASP and PAMP decreased apparently immediately after the operation（P〈0.05）.The pulmonary pressure was decreased during the following 6 months（P〈0.05）.Conclusion Transcatheter closure of VSD with mild or moderate pulmonary hypertension is safe and effective.