婴幼儿动脉导管未闭合并肺动脉高压的介入治疗

Transcatheter closure of patent ductus arteriosus with pulmonary hypertension in children

目的 :评价经导管堵闭法治疗婴幼儿动脉导管未闭 (PDA)合并肺动脉高压的临床疗效。方法 :1 998年 1 2月～2 0 0 2年 4月对 1 4例合并肺动脉高压的婴幼儿PDA实施经导管介入治疗 ,男 4例 ,女 1 0例 ;年龄 7～ 36月 ,平均 1 4 .8± 4 .6月 ;体重 6 .5～ 1 3 .5kg ,平均 1 1 .0± 2 .3kg ;行左、右心导管检查及主动脉弓降部造影 ,确定PDA位置、形状及直径 ,以AGA公司蘑菇伞堵闭器行介入治疗。结果 :主动脉弓降部造影显示PDA属Krichenko形态A1型 8例 ,A2型 5例 ,B2型 1例 ;Qp/Qs2 .1～ 5 .7,平均 3 .4± 1 .2 ;最窄内径 3 .4～ 1 0 .8mm ,平均 4 .8± 2 .9mm ;术前肺动脉压为 67.0± 2 4 .6/ 37.8± 8.9mmHg ,主动脉压为 88.5± 1 4 .6/ 4 6 .5± 1 1 3mmHg。 1 4例患儿均应用蘑菇伞堵闭器堵闭 ,成功率 1 0 0 % ;术后 30min心血管造影显示 ,5例可见极少量残余分流 ,术后 2 4h心脏彩超复查 2例有少量残余分流 ,术后 1月彩超复查 1例有少量残余分流 ,术后3月复查皆无残余分流 ;术后 30min肺动脉压降为 39.8± 1 3 .3/ 2 0 .2± 1 2 .3mmHg,主动脉压升至 95 .6± 1 8.4/ 58.0±1 2 1mmHg ,住院天数 4～ 2 7天 ,平均 9.8± 5 .3天 ;术后住院天数 2～ 9天 ,平均 4 .3± 1 .8天 ,无严重并发症发生。结论 :经导管?

Objective:Evaluating the method of transcatheter closure of patent ductus arteriosus(PDA) with pulmonary hypertension in children less than 3 years.Methods:Transcatheter closure of PDA was performed in 14 patients(4 male and 10 female), aged 7 to 36 months, with the narrowest PDA diameter of 3.4 to 10.8mm.Results:Transcatheter closures were successful performed in all patients. Amplatzer duct occluder was used in all patients. Only 2 of 14 patients had a very small shunt at 24 hours after occlusion,1 patient had small residual shunt after 1 month, and no residual shunt 3 months later. After the procedure the pulmonary arterial pressure decreased from 67.0±24.6/37.8±8.9mmHg to 39.8±13.3/20.2±12.3mmHg ,aortic pressure increased from 88.5±14.6/46.5±11 3mmHg to 95.6±18.4/58.0±12.1mmHg.Conclusion:Transcatheter closure of patent ductus arteriosus with pulmonary hypertension in children less than 3 years is a simple, effective, and safe method.