应用Amplatzer封堵器经导管治疗动脉导管未闭并发重度肺动脉高压的疗效评价

Therapeutic evaluation on patent ductus arteriosus with severe pulmonary hy pertention by using the Amplatzer occluder

目的 :应用 Amplatzer封堵器经导管治疗动脉导管未闭 (PDA)并发重度肺动脉高压 (SPH) ,并对其疗效进行评价。方法 :全组 15例 ,年龄 2 5± 2 2 (5～ 54)岁。PDA最窄处直径为 11± 4(8～ 18) mm。 PDA 8例采用 AmplatzerPDA封堵器治疗 ,7例采用 Amplatzer房间隔缺损封堵器治疗。封堵后 3 0 min行侧位降主动脉造影 ,术后 1d及 1月行超声心动图检查 ,观察有无残余分流及 PDA再通。结果 :14例 (93 ) %封堵后 3 0 min至 1h肺动脉收缩压由 90～ 150 (10 6± 2 7) mm Hg降至 45～ 110 (65± 2 1) mm Hg,肺动脉平均压由 60～ 10 5(82± 2 1) mm Hg降至 2 6～ 65(50± 19) mm Hg。 1例封堵后 3 0 min至 1h肺动脉收缩压无下降 ,反而有轻度上升 ,考虑为阻力性重度肺动脉高压 ,撤出封堵器。 6例主动脉压力有不同程度增高。术后 3 0 min降主动脉造影示 ,5例存在微至少量残余分流 ,10例封堵完全无残余分流。在术后 2 4h2例仍存在微至少量残余分流 ,其中 1例并发溶血 ,48h后行外科 PDA缝合术。其余病例术后 1月超声心动图检查未见残余分流及再通。结论 :应用 Amplatzer封堵器治疗 PDA并发

AIM: To investigate the use of the Amplatzer occlu de r device(including duct and septal occluder) for treatment of patent ductus arte riosus (PDA) with severe pulmonary hypertention(SPH). METHODS: 15 pati ents with large PDA and systemic and near systemic pulmonary artery pressure und erwent attempted transcatheter closure using the Amplatzer occluder device at a median age of 25±22 (range 5 to 54) years. The mean diameter of residual PDA at its narrowest segment was 11±4 (rang 8 to 18) mm. 8 patients suffering fr o m PDA with SPH underwent attempted transcatheter closure of a PDA with the Ampla tzer ductal occluder, 7 cases with the Amplatzer atrial septal defect occluder device. The lateral descending aortographies were performed to evaluate the imm ediate results 30 minutes after the procedure. Echocardiographies were performed 1 day, 1 month after the closure to find whether there was residual shunt and r ecanalization. RESULTS: The systolic pulmonary pressure decreased fr om 90~150(106±27)mm Hg to 45~110(65±21)mm Hg,the mean pulmonary pressure decreased from 60~105(82±21) mm Hg to 26~65(50±19)mm Hg in 14 cases after temporary closure,implying permanent transcatheter cloure. Pulmonary pressure f ailed to respond in one case after the temopary closure,implying resistant pulmo nary hypertension, and the Amplatzer occ lude r device was removed from the body. Arotic pressure increase occurred in 6 patie nts.Angiography showed that 10 patients had complete immediate closure, 5 had a trace to small shunt 30 minutes after the procedures. At 24 h, color Doppler rev ealed that there were still a trace to small shunt in 2 patients. One pati ent de veloped hemolysis 24 hours after the procedure and surgical closure of the ductu s arteriosus was subsequently performed 48 hours after the procedure. No residu al shunt and PDA recanlization were found in the rest cases one month after th e closure. CONCLUSION: Transcatheter closure of larg e PDAs associated with h igh SPH using the Amplatzer occluder device is a safe and effective interventio nal therapy. Further studies are reguired to document its efficacy, safety and long term results in a large number of patients.