室间隔缺损阻力型肺动脉高压术后血流动力学随访观察

Postoperative hemodynamic parameter follow-up in children with severe pulmonary resistance hypertension due to ventricular septal detect

目的 :研究先天性心脏病 (先心病 )左向右分流合并重度肺动脉高压术时年龄与预后的关系。方法 :对室间隔缺损 (室缺 )合并重度肺动脉高压 (全肺循环阻力增加 )的 4 0例患儿 ,用心导管的方法进行术前、术后 1周内及术后 5～ 7年的心脏血流动力学随访测定。结果 :≤ 2岁组与 >2岁组比较 ,肺动脉 /主动脉收缩压比值 (pp/ps)及阻力之比值 (Rp/Rs)和全肺阻力 (PVR)及肺小动脉阻力 (PAR)差异有显著性意义 ,P<0 .0 1。≤ 2岁组随访中血流动力学参数完全恢复正常 ,而 >2岁组则 pp/ps、Rp/Rs接近正常 ,肺血管阻力未完全恢复至正常。结论 :室缺合并重度肺高压要获得良好的远期疗效 ,消除肺血管病变的关键是年龄 ,早期予以手术治疗是根本的选择。

Objective: To study the relationship between the age at operation and prognosis in children with severe pulmonary hypertension (PH) due to ventricular septal defect (VSD). Methods: Forty children with severe PH (increased total pulmonary circulation resistance)due to VSD were divided into two groups based on age at ope ration(Group Ⅰ aged less than 2 years and group Ⅱ more than 2 years). The hemodynamic parameter follow up was measured by cardiac catheterization at presurgery, one week after surgery and 5 7 years postoperatively. Results: The ratio of pulmonary arterial pressure and systemic arterial pressure (p p/p s),pulmonary resistance and systemic resistance (R p/R s), and pulmonary vascular resistance (PVR) and small pulmonary arterial resistance (PAR) were significantly different in two groups ( P <0.01). During follow up in the group less than 2 years, all the hemodynamic parameters were at normal level, while in the group more than 2 years, only p p/p s and R p/R s were close to normal level. The pulmonary arterial resistance was still abnormal. Conclusion: An early operation may be the only way to gain optimal long term result of surgery and decrease the incidence of pulmonary vascular disease in children with PH due to VSD.[