成人动脉导管未闭合并重度肺动脉高压介入封堵术后左心功能不全

Left Ventricular Dysfunction after Transcatheter Closure of Patent Ductus Arteriosus in Adults with Severe Pulmonary Arterial Hypertension

目的评估成人动脉导管未闭(PDA)合并重度肺动脉高压(PAH)患者介入封堵术后左心功能变化,并分析术后左心功能不全的预测指标。方法回顾性分析2005年11月至2014年11月41例成功接受介入封堵术的成人PDA合并重度PAH患者(肺动脉平均压力≥50 mmHg伴肺血管阻力指数≤8 WU·m^(2)),并对术后左心功能变化进行随访观察。应用单因素及多因素logistic回归分析对术后左心功能不全相关指标进行评估。结果本组41例患者术前PDA平均直径为(8.9±2.9)mm,左心室舒张末期内径为(63.3±9.3)mm,左心室射血分数为(60.2±7.9)%。右心导管检查提示肺动脉平均压力为(65.3±11.2)mmHg,肺血管阻力指数为(4.7±1.9)WU·m^(2),肺循环血流量/体循环血流量为2.5(1.8,3.2)。封堵后肺动脉平均压力降至(27.2±6.2)mmHg(P<0.01)。本组患者中位随访时间为6(1,24)个月,随访过程中12例(29.3%)患者出现左心功能不全,其中9例(75.0%)患者左心功能恢复。单因素及多因素logistic回归分析提示术前左心室舒张末期内径是成人PDA合并重度PAH患者介入封堵术后左心功能不全的独立预测因子[比值比(OR)=1.299,95%置信区间(95%CI):1.069~1.579,P=0.009]。结论成人PDA合并重度PAH患者介入封堵术后近1/3的患者出现左心功能不全,其中多数患者能够恢复正常。术前左心室舒张末期内径是术后左心功能不全的独立预测指标。

Objective To evaluate the left ventricular(LV)function after transcatheter closure of patent ductus arteriosus(PDA)in adults with severe pulmonary arterial hypertension(PAH)and identify the potential predictors.Methods This retrospective study enrolled the adult patients with PDA and severe PAH who underwent successful transcatheter closure between November 2005 and November 2014.During right heart catheterization,all patients had mean pulmonary arterial pressure≥50 mmHg with pulmonary vascular resistance index≤8 WU.m^(2).LV function was followed up after closure of PDA.Univariate and multivariate logistic analysis was used to identify the potential predictors of postoperative LV dysfunction.Results Of the 41 included patients,the size of PDA was(8.9±2.9)mm,left ventricular end diastolic dimension was(63.3±9.3)mm,left ventricular ejection fraction was(60.2±7.9)%,mean pulmonary arterial pressure was(65.3±11.2)mmHg,pulmonary vascular resistance index was(4.7±1.9)WU.m^(2),and the median pulmonary to systemic flow ratio was 2.5(1.8,3.2).After closure of PDA,mean pulmonary arterial pressure decreased to(27.2±6.2)mmHg(P<0.01).Twelve(29.3%)patients had postoperative LV dysfunction,among which 9(75.0%)recovered during follow up(median,6[1,24]months).Univariate and multivariate logistic regression analysis suggested that preoperative left ventricular end diastolic dimension was an independent predictor of postoperative LV dysfunction(odds ratio[OR]=1.299,95%confidence interval[95%CI]:1.069-1.579,P=0.009).Conclusion In nearly 1/3 of adult patients with PDA and severe PAH,LV dysfunction occurred after transcatheter closure and most of them gradually returned to normal.Preoperative left ventricular end diastolic dimension may be an independent predictor of postoperative LV dysfunction.