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经皮肺静脉支架成形术治疗慢性纤维性纵隔炎所致严重肺静脉狭窄初探 被引量:7

Feasibility and efficacy of percutaneous pulmonary vein stenting for the treatment of patients with severe pulmonary vein stenosis due to fibrosing mediastinitis
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摘要 目的 探讨经皮肺静脉支架成形术治疗慢性纤维性纵隔炎所致严重肺静脉狭窄的可行性和安全性.方法 回顾性分析2018年1至6月在甘肃省人民医院心内科和上海交通大学胸科医院诊断为慢性纤维性纵隔炎所致严重肺静脉狭窄5例患者的临床资料,其中男性2例,女性3例,年龄54~77岁.对病变肺静脉行选择性造影,在严重狭窄处逐级球囊扩张并置入支架.术后6个月对疗效及安全性进行评估.结果 5例患者共11支肺静脉存在严重狭窄,均置入裸金属球囊支架,直径7~10 mm,长度17~27 mm.肺静脉狭窄程度从术前的(83±16)%减至术后的(12±4)%(P<0.01),肺静脉最窄段直径从术前的(0.8±0.5)mm扩大至术后的(7.5±0.8)mm(P<0.01),跨狭窄压差由术前的(27.0± 15.1)mmHg(1 mmHg=0.133 kPa)下降至术后的(2.50±0.58)mmHg(P<0.05),肺动脉平均压由术前的(45.0±9.0)mmHg下降至术后的(38.7±8.4)mmHg(P<0.05).1例患者在球囊支架扩张过程中因迷走反射出现短暂性心脏骤停,经复苏后恢复.随访期间,1例患者CT肺血管成像示肺静脉支架置入近端受纤维纵隔组织压迫致狭窄加重,1例患者因停用抗凝药CT肺血管成像示支架内附壁血栓形成.结论 经皮肺静脉支架成形术治疗慢性纤维性纵隔炎所致严重肺静脉狭窄安全、可行,可即刻改善患者血流动力学状态. Objective To evaluate the feasibility and safety percutaneous pulmonary vein intervention in patients with severe pulmonary vein stenosis (PVS) caused by fibrosing mediastinitis(FM). Methods This retrospective analysis included 5 FM patients (2 male, 3 female, 54-77 years old) confirmed by clinical presentation and chest computed tomography (CT) scan from January to June 2018 who were from Gansu Provincial Hospital and Shanghai Chest Hospital. CT pulmonary angiography (CTPA) further revealed severe PVS caused by fibrotic tissue compression in mediastinum. After selective pulmonary vein angiography, gradually balloon angioplasty was used to expand the pulmonary vein and then stents were implanted in the pre-dilated stenotic pulmonary veins. Evaluation of therapeutic effect was made at 6 months after the procedure. Results All of 11 serious compression PVS were treated with stent implantation (diameter: 7-10 mm, length: 17-27 mm). After stenting, degree of pulmonary vein stenosis decreased from (83 ± 16)% to (12 ± 4)% (P<0.01). The minimal diameter of the stenotic pulmonary vein was significantly increased from (0.8±0.5)mm to (7.5±0.8)mm (P<0.01). Trans-stenotic gradient decreased from (27.0±15.1) mmHg (1 mmHg=0.133 kPa) to (2.50±0.58)mmHg (P<0.05). Mean pulmonary pressure measured by cardiac catheter decreased from (45.0 ± 9.0)mmHg to (38.7 ± 8.4)mmHg (P<0.05). One patient experienced cardiac arrest due to vagal nerve reflex during big sizing balloon stent dilation and recovered after cardiopulmonary resuscitation. There were no other serious procedure related complications. During the follow-up, severe stenosis at end of proximal stent was evidenced in 1 patient due to fibrotic compression, and another patient developed in-stent thrombosis due to discontinuation of prescribed anticoagulant. Conclusion Percutaneous intervention for severe pulmonary vein stenosis caused by FM is feasible and safe, and can improve hemodynamic caused by the compression of mediastinal vascular structures in these carefully selected patients.
作者 周星 李艳杰 曹云山 苏红玲 段一超 苏新 危蓉 褚嫒嫒 朱岩 黄晏 张敏 潘欣 Zhou Xing;Li Yanjie;Cao Yunshan;Su Hongling;Duan Yichao;Su Xin;Wei Rong;Chu Ai'ai;Zhu Yan;Huang Yan;Zhang Min;Pan Xin(Department of Radiology,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Cardiology,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China;Department of Cardiology,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Pathology,Gansu Provincial Hospital,Lanzhou 730000,China)
出处 《中华心血管病杂志》 CAS CSCD 北大核心 2019年第10期814-819,共6页 Chinese Journal of Cardiology
基金 中国科学院"西部之光"人才培养引进计划。
关键词 纵隔炎 支架 肺静脉狭窄 Mediastinitis Stents Pulmonary vein stenosis
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