慢性血栓栓塞性肺动脉高压患者外科术后发生进展性肺动脉高压行序贯式肺动脉球囊扩张治疗结果

Pulmonary balloon angioplasty for patients with chronic thromboembolic pulmonary hypertension accompanying with progressed pulmonary hypertension after pulmonary endarterectomy

目的探索慢性血栓栓塞性肺动脉高压(CTEPH)患者行肺动脉内膜剥脱术(PEA)后出现进展性肺动脉高压行后行分期序贯式肺动脉球囊扩张成形术(PBA)治疗的技术要点。方法回顾性收集自2014年至2017年7例行序贯式PBA的慢性血栓栓塞性肺动脉高压(CTEPH)患者的临床资料,并进行1年以上定期随访。随访内容包括患者心功能结果,行PBA的球囊扩张次数及右心导管结果、超声结果等。其中男1例、女6例,年龄58(43~59)岁。结果7例患者行PEA后出现肺动脉压力阻力进展性增高,随访期间予以序贯式PBA,包括单次球囊扩张治疗1例,多次球囊扩张治疗6例。术后第11(6~14)个月后首次行PBA,球囊扩张次数为2(2~6)次,单次球囊扩张治疗干预3~5个肺动脉段,与首次球囊扩张治疗前最近一次右心导管结果相比,肺动脉收缩压[从53(47~75)mmHg降低至45(40~54)mmHg,P=0.042],肺动脉平均压[从38(29~47)mmHg下降至29(25~39)mmHg,P=0.043],氨基酸末端脑钠素前体[从1872(1598~2898)pg/ml下降至164(72~334)pg/ml,P=0.018)均明显改善,7例患者均进行12个月以上随访(中位随访时间14个月),序贯式PBA治疗后心功能均改善为WHOⅠ~Ⅱ级(P<0.05)。结论PEA后出现进展性肺动脉高压合并心功能改善不佳的患者行序贯式PBA可进一步减轻该类患者右心后负荷,改善心功能。

Objective To describe the effect of sequential pulmonary balloon angioplasty for patients with chronic thromboembolic pulmonary hypertension, who was accompanied with progressed pulmonary hypertension after pulmonary endarterectomy surgeries. Methods From 2014 to December 2017, 7 patients were treated with a combination therapy of pulmonary endarterectomy and sequential pulmonary balloon angioplasty. There were 1 male and 6 females at age of 58 (43–59) years. A follow-up period of more than 1 year was accomplished. The result of right sided heart catheterization and ultrasonic cardiogram between and after the pulmonary endarterectomy or balloon angioplasty was collected. Results Seven patients were treated with a combination of pulmonary endarterectomy and sequential pulmonary balloon angioplasty, which included 1 patient of single pulmonary balloon angioplasty and 6 patients of multiple pulmonary balloon angioplasties. The balloon dilation times was 2 (2–6), and the number of segments during each single balloon dilatation was 3–5, compared with the first clinical results before the first balloon dilation, systolic pulmonary artery pressure [53 (47–75) mm Hg vs. 45 (40–54) mm Hg, P=0.042),mean pulmonaryartery pressure [38 (29–47) mm Hg vs. 29 (25–39) mm Hg, P=0.043], N terminal-B type natriuretic peptide [1 872 (1 598–2 898) pg/ml vs. 164 (72–334) pg/ml, P=0.018] improved significantly after the last balloon angioplasty. Heart function classification (NYHA) of all the 7 patients were recovered to Ⅰ-Ⅱclasses (P<0.05). Conclusion Sequential pulmonary balloon angioplasty after pulmonary endarterectomy can further reduce the patient's right heart after load, improve the heart function for patients with progressed pulmonary hypertension after pulmonary endarterectomy surgeries.