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国产封堵器介入治疗小儿动脉导管未闭并发肺动脉高压的临床疗效(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第3期
页码:
323-326
栏目:
临床研究
出版日期:
2008-05-20

文章信息/Info

Title:
Transcatheter closure of patent ductus arteriosus with pulmonary hypertension using domesticmade mushroom occluder in children
作者:
沈桂冬1; 代政学1; 樊川民2; 张玉顺1; 李寰1; 郭文怡1; 王海昌1
1.第四军医大学西京医院心内科，陕西 西安 710032； 2.咸阳市第二人民医院心内科，陕西 咸阳 712000
Author(s):
SHEN Guidong;  DAI Zhengxue;  FAN Chuanmin;  ZHANG Yushun;  LI Huan;  GUO Wenyi;  WANG Haichang
Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China
关键词:
动脉导管未闭; 肺动脉高压; 介入治疗; 封堵器; 国产
Keywords:
patent ductus arteriosus;  pulmonary hypertension;  transcatheter closure;  domesticmade mushroom occluder
分类号:
R654.2
DOI:
-
文献标识码:
A
摘要:
目的 评价国产封堵器经导管介入治疗小儿动脉导管未闭(PDA)并发肺动脉高压的临床疗效。方法 回顾分析2003年12月～2007年11月86 (男30，女56) 例小儿PDA并发肺动脉高压实施经导管介入治疗；年龄8月～12 (8±7)岁；体质量11～46(31±8)kg；行左、右心导管检查及主动脉弓降部造影，确定PDA位置、形状及大小，PDA最窄处内径4～13(7±5)mm。以国产蘑菇伞堵闭器行介入治疗，根据封堵实验决定能否行永久封堵。术后24 h、1个月、3个月、6个月、1年行彩色多普勒超声心动图检查。结果 2例(2%)封堵后30 min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。余84例(98%)术后30 min肺动脉压收缩压由术前平均(69±24)mmHg（1 mmHg=0133 kPa）降为(36±14)mmHg(P<005)，肺动脉平均压由术前(45±14)mmHg降为(30±8)mmHg(P<005)，主动脉压由术前(94±10)mmHg升至(99±6)mmHg，但无统计学差异。术后30 min主动脉弓降部造影显示，18例(21%)可见极少量残余分流，术后24 h心脏彩超复查4例(4%)有少量残余分流，术后1月彩超复查皆无残余分流；无严重并发症发生。结论 国产蘑菇伞经导管封堵治疗儿童PDA并发肺动脉高压，安全、有效，值得推广应用。
Abstract:
AIM To evaluate the efficiency of domesticmade mushroomshape occluder in children transcatheter closure of patent ductus arteriosus (PDA) with pulmonary hypertension. METHODS Eightsix children (30 male and 56 female) with PDA underwent transcatheter closure using domesticmade mushroomshape occluder. The median age of the patients was (8±7)years (ranging from 8 mon to 12 y) and the mean weight was (31±8)kg (ranging from11 kg to 46 kg). The mean PDA diameter of narrowest segment was (7±5)mm (ranging from 4 mm to 13 mm). The achievement of permanent transcatheter closure was decided by the changes of the pulmonary arterial pressure, aortic pressure and oxygen saturation. Followup evaluation was performed respectively by color flow mapping at 24 hours, 1 month, 3 months, 6 months and 1 year after closure. The lateral descending aortography was performed to evaluate the immediate results at 30 min after the procedure. RESULTS The devices were successfully deployed in all the patients except 2 patients, owing to obstructive pulmonary hypertension. The systolic pulmonary pressure decreased from (69±24)mmHg to (36±14)mmHg (P<005), the mean pulmonary pressure decreased from (45±14)mmHg to (30±8)mmHg (P<005), and aortic pressure increased from (94±10)mmHg to (99±6)mmHg. Complete angiographic closure was found 30 minutes after the device deployment in 66 out of 84 patients (79%), while small leak was present in 18 patients(21%). Complete echocardiographic closure was demonstrated in 80 out of 84 patients (95%) within 24 h and 100% at 1month followup in all the patients. There was no PDA recanalization and migration of devices after the complete occlusion during 1-12 mon following up. CONCLUSION Anterograde transeatheter closure using the domesticmade mushroomshape occluder is a safe and effective interventional therapy for PDA with pulmonary hypertension in children.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2007-09-14.通讯作者:王海昌,主任医师,主要从事冠心病的基础与临床研究Email: wanghc@fmmu.edu.cn 作者简介：沈桂冬，硕士生Email:shengd007@163.com
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