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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(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2003年第6期
页码:
545-548
栏目:
介入治疗
出版日期:
2003-11-01

文章信息/Info

Title:
Therapeutic evaluation on patent ductus arteriosus with severe pulmonary hypertention byusing the Amplatzer occluder
作者:
代政学1; 李毓杰2; 王垒3; 张玉顺1; 王海昌1; 贾国良1; 李寰1; 刘建平1; 王小燕1
1.第四军医大学西京医院心血管内科, 陕西 西安 710032;2.西安市第一医院干部病房, 陕西 西安 710003;3.西安市儿童医院儿内科, 陕西 西安710004
Author(s):
DAI Zheng-xue1;  LI Yu-jie2;  WANG Lei3;  ZHANG Yu-shun1;  WANG Hai-chang1;  JIA Guoliang1;  LI Huan1;  LIU Jian-ping1;  WANG Xiao-yan1
1.Cardiology Department of Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
关键词:
动脉导管未闭; 重度肺动脉高压; 介入治疗
Keywords:
ductus arteriosus; patent;  severe pulmonary hypertention;  transcatheter closure
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
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25±22(5～54)岁。PDA最窄处直径为11±4(8～18)mm。PDA8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30min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30min至1h肺动脉收缩压由90～150(106±27)mmHg降至45～110(65±21)mmHg,肺动脉平均压由60～105(82±21)mmHg降至26～65(50±19)mmHg。1例封堵后30min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30min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24h2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SPH是一种安全有效的介入方法。
Abstract:
AIM: To investigate the use of the Amplatzer occluder device (including duct and septal occluder) for treatment of patent ductus arteriosus (PDA) with severe pulmonary hypertention (SPH). METHODS: 15 patients with large PDA and systemic and near systemic pulmonary artery pressure underwent 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 from PDA with SPH underwent attempted transcatheter closure of a PDA with the Amplatzer ductal occluder,7 cases with the Amplatzer atrial septal defect occluder device. The lateral descending aortographies were performed to evaluate the immediate results 30 minutes after the procedure. Echocardiographies were performed 1 day, 1 month after the closure to find whether there was residual shunt and recanalization. RESULTS: The systolic pulmonary pressure decreased from 90～150(106±27)mm Hgto45～110(65±21) mmHg, the mean pulmonary pressure decreased from 60～105(82±21)mmHg to 26～65(50±19)mmHg in 14 case safter temporary closure, implying permanent tran-scatheter cloure. Pulmonary pressure failed to respondin one case after the temopary closure, implying resistant pulmonary hypertension, and the Amplatzer occluder device was removed from the body. Arotic pressure increase occurred in 6 patients. Angiography showed that 10 patients had complete immediate closure, 5 had a trace to small shunt 30 minute safter the procedures. At 24h, color Doppler revealed that there were still a trace to small shunt in 2 patients. One patient developed hemolysis 24 hour safter the procedure and surgical closure of the ductus arteriosus was subsequently performed 48 hour safter the procedure. No residual shunt and PDA recanlization were found in the rest cases one month after the closure. CONCLUSION: Transcatheter closure of large PDA sassociated with high SPH using the Amplatzer occluder device is a safe and effective interventional therapy. Further studies are reguired to document its efficacy, safety and long term results in a large number of patients.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2003-01-12.
更新日期/Last Update: 2003-11-01