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国产蘑菇伞介入治疗成人动脉导管未闭的临床疗效评价

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第6期
页码:
823-825
栏目:
临床研究
出版日期:
2009-11-05

文章信息/Info

Title:
Clinical evaluation of catheter closure of patent ductus arteriosus by Chinese-made mushroom-shape occluder in adults
作者:
代政学1; 沈贵冬2; 李寰1; 张玉顺3; 郭文怡1; 王海昌1; 杨省利1
1.第四军医大学西京医院心内科，陕西 西安 710032；2.安康市中心医院心内科, 陕西 安康 725000；3.西安交通大学第一附属医院心内二科，陕西 西安 710061
Author(s):
DAI Zheng-xue;  SHEN Gui-dong;  LI Huan;  ZHANG Yu-shun;  GUO Wen-yi;  WANG HAi-chang;  YANG Sheng-li
Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China
关键词:
成人; 动脉导管未闭; 介入治疗; 国产蘑菇伞
Keywords:
patent ductus arteriosus;  adult;  catheter closure;  domestic-made mushroom-shape occluder
分类号:
R654.2
DOI:
-
文献标识码:
A
摘要:
目的: 评价国产蘑菇伞经导管介入治疗成人动脉导管未闭(PDA)的临床疗效。方法: 选择我科156(男54，女102)例成人PDA实施经导管介入治疗的患者，年龄18～65(32±13)岁；体质量43.8～68.5(51±8)kg；行右心导管检查测定肺动脉压力、主动脉压力，行主动脉弓降部造影，确定PDA位置、形状及大小，PDA最窄处内径1.5～18.2 (5±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、3、6 和12个月行彩色多普勒超声心动图检查随访。结果: 4例封堵后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152例成功地植入封堵器，术后30 min肺动脉压收缩压由术前(48±23)mmHg降为(36±12)mmHg(P<0.05)，肺动脉平均压降由术前(40±14)mmHg降为(27±11)mmHg(P<0.05)，主动脉压由术前(102±13)mmHg变化至(107±14)mmHg(P>0.05)。术后30 min主动脉弓降部造影显示，119例(78.3％)封堵完全，33例(21.7％)可见极少量残余分流，术后24 h心脏彩超复查147例(96.7％)封堵完全，5例(3.3％)有少量残余分流，术后1个月彩超复查皆无残余分流；无再通和堵闭器移位等并发症发生。结论: 在不可逆性阻力性重度肺动脉高压发生前应用国产蘑菇伞经导管封堵治疗成人PDA是一种安全、简便、有效、创伤小、恢复快的方法。
Abstract:
AIM: To evaluate the treatment efficiency of catheter closure of patent ductus arteriosus (PDA) by Chinese-made mushroom-shape occluder in adults. METHODS: A total of 156 adults with PDA (54 males and 102 females) underwent attempted catheter closure by Chinese-made mushroom-shape occluder. Pulmonary arterial pressure, aortic pressure and oxygen saturation were measured. Aortography showed that the mean PDA diameter of the narrowest segment was (5.2±4.9) mm (range: 1.5-18.2 mm). Lateral descending aortographies were performed to evaluate the immediate results 30 min after the procedure. Follow-up evaluation was performed with color flow mapping at 24 h, 1 month, 3 months, 6 months and 1 year after closure. RESULTS: The devices were successfully placed in 152 patients (with the exception of four patients due to obstructive pulmonary hypertension). Thirty minutes after closure, systolic pulmonary pressure in the successful cases decreased from (48.2±22.6) to (35.6±12.4) mmHg (P<0.05), the mean pulmonary pressure decreased from (40.2±14.5) mmHg to (27.2±10.7) mmHg (P<0.05) and aortic pressure increased from (102.2±12.6) to (106.6±13.8) mmHg (P>0.05). Complete angiographic closure was seen 30 min after placement of device in 119/152 patients (78.3%), whereas small leaks were observed in 33 cases (21.7%). Complete echocardiographic closure was observed in 147/152 successful cases (96.7%) within 24 h and 100% at 1-month follow-up in all patients. There was no PDA recanalization, migration of devices or other complications after complete occlusion during 1-12 months of follow up. CONCLUSION: Catheter closure of adult PDA using Chinese-made mushroom-shape occluder is a safe and effective method used before the occurrence of obstructive pulmonary hypertension.

参考文献/References

［1］ Masura J, Walsh KP, Thanopoulous B, et al. Catheter closure of moderate to large-sized patent ductus arteriosus using the new Amplatzer Duct Occluder：Immediate and short-term results［J］. J Am Coll Cardiol, 1998, 31(4)：878-882．

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［4］ 李俊杰,张智伟,钱明阳，等． 应用国产封堵器介入治疗小儿动脉导管未闭的远期疗效 ［J］． 岭南心血管病杂志， 2008， 14(1)：11-14．

［5］ 黎励文,黄文晖,黄奕高，等．国产封堵器介入治疗成人动脉导管未闭的长期疗效观察［J］. 南方医科大学学报， 2007， 27 (7)：1079-1080．

［6］ 石继军，曾国洪，张智伟，等． 国产动脉导管未闭封堵器的临床应用及疗效评价［J］． 中华放射学杂志, 2003， 37(8)：723-726．

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［9］ Krichenko A, Benson LN, Burrows P, et al. Angiographic classmcation of the isolmed, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion［J］. Am J Cardiol, 1989, 63(12)：877-880．

［10］王树祥，张玉顺，代政学． 成人动脉导管未闭的介入治疗进展［J］． 心脏杂志， 2002， 14(6)：546-549．

［11］阮英茆,朱晓东,程显声，等. 100例先天性心脏病肺动脉高压肺活检病理分级的初步探讨［J］． 中国循环杂志， 1992， 29(1)：54-57.

［12］代政学，张玉顺，贾国良，等． Amplatzer封堵器试验性关闭动脉导管未闭合并重度肺动脉高压的临床意义［J］． 第四军医大学学报， 2001， 22(21)：1924-1926．

备注/Memo

备注/Memo:
收稿日期：2008-11-12.作者简介：代政学，副教授，副主任医师，博士Email:daizhex@fmmu.edu.cn
更新日期/Last Update: 2009-09-30