房间隔分流器在重度肺动脉高压患者中的应用

Application of interatrial shunt device in patients with severe pulmonary hypertension

肺动脉高压(pulmonary arterial hypertension,PAH)是一种严重的进展性疾病,可导致右心功能衰竭,并最终死亡。对于靶向药物联合治疗无效或世界卫生组织心功能分级维持在Ⅲ级或Ⅳ级的PAH患者建议行肺移植。然而,只有3%PAH患者有机会获得肺移植。一种新型的房间隔分流器(interatrial shunt device,ISD)可通过球囊房间隔造口术建立一个相对固定的右向左的分流,从而使右心减压,缓解右心衰竭的症状,促进左心充盈,改善心输出量和器官灌注,降低晕厥、急性PAH危象和死亡的发生率,尽管动脉血氧饱和度可能不佳,但右向左分流可以改善体循环血管床氧输送。ISD置入术操作简单易行,透视和手术时间短,手术安全,目前临床研究中期随访无重大并发症,无血栓形成,且均保持通畅。患者的晕厥症状、6分钟步行距离、心脏指数和全身氧输送均有显著改善。ISD或许是目前耐药重度PAH患者改善症状和延长生存期的最后替代治疗。

Pulmonary arterial hypertension(PAH)is a severe,progressive disease leading to right ventricular failure and finally death.Lung transplantation is recommended for PAH patients who do not respond to targeted drug combination therapy or World Health Organization functional class(WHO FC)ⅢorⅣ.However,only 3%of PAH patients can recieve the lung transplantation.A novel implantable interatrial shunt device(ISD)can create a relatively fixed right-to-left shunt established by balloon atrial septostomy(BAS).The device may decompress the right sided chambers,facilitate left heart filling,improve organ perfusion and reduce the likelihood of syncope,acute pulmonary hypertensive crisis and death.The systemic oxygen transport improves despite hypoxemia.Implantation is simple,feasible and safe,and the X-ray time and operation time are short.There is no severe complication or thrombosis during the mid-term follow-up of the clinical studies and the device remained patent.The syncope symptoms,six-minute walk distance,cardiac index and systemic oxygen transport improve significantly in the patients.ISD may be currently the last alternative treatment to improve symptoms and prolong survival in currently drug-resistant patients with severe PAH.