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|本期目录/Table of Contents|

动脉导管未闭并重度肺动脉高压封堵术后肺动脉压力变化

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第6期
页码:
708-712
栏目:
临床研究
出版日期:
2014-06-25

文章信息/Info

Title:
Changes of pulmonary artery pressure after transcatheter closure of patent ductus arteriosus complicated with severe pulmonary arterial hypertension
作者:
张端珍; 朱鲜阳; 崔春生; 侯传举; 王琦光
（沈阳军区总医院先心病内科，辽宁 沈阳 110840）
Author(s):
ZHANG Duan-zhen;  ZHU Xian-yang;  CUI Chun-sheng;  HOU Chuan-ju;  WANG Qi-guang
(Department of Congenital Heart Disease, General Hospital, Shenyang Military Area Command, Shenyang 110840, Liaoning, China)
关键词:
动脉导管未闭; 肺动脉高压; 介入治疗; 心脏病; 先天性
Keywords:
patent ductus arteriosus;  pulmonary arterial hypertension;  interventional therapy;  congenital heart disease
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:探讨动脉导管未闭（patent ductus arteriosus，PDA)并发重度肺动脉高压（pulmonary arterial hypertension，PAH)经导管封堵术后肺动脉压力（pulmonary artery pressure，PAP)变化及其与术后PAH的关系。方法： 对111例肺动脉平均压（mean pulmonary artery pressure，mPAP)>55 mmHg，肺/体循环血量比值（Qp/Qs）>1.5的PDA患者实施封堵术，术中实时监测封堵术前后PAP变化，术后定期随访并行超声心动图检查。结果： 所有患者均成功实施封堵术，术后即刻PAP显著降低（P<0.05），但mPAP恢复正常仅37例（33.3%），另有轻度、中度和重度PAH患者51（49.5%），14（12.6%）和9例（8.1%）。随访1~8（中位数4）年。术后3个月共24例（21.6%）患者存在PAH，其中9例术后6个月PAP恢复正常，另外15例（13.5%）PAH持续存在。术后PAP最终恢复正常的患者封堵术后即刻mPAP降低（59±10）%，术后存在持续性PAH者仅降低（24±14）%。术后即刻PAP正常和轻度PAH者术后PAP最终均恢复正常，而术后即刻存在重度PAH者随访期间PAH持续存在。结论： 在并发重度PAH的PDA患者中，即使Qp/Qs>1.5，仍有13.5%的患者存在术后持续性PAH；关闭PDA后导管测量PAP为重度PAH者，术后PAH不可避免；如果术后6个月PAP仍然高于正常，PAH将持续存在。
Abstract:
AIM:To evaluate the changes of pulmonary artery pressure (PAP) in patients with patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension (PAH) after transcatheter device closure. METHODS: Transcather closure of PDA was performed in 111 patients with mean PAP (mPAP) >55 mmHg and pulmonary-to-systemic flow ratio (Qp/Qs) >1.5. PAP and aortic pressure were measured before and after device closure. Patients were followed clinically and with echocardiogram. RESULTS: All patients underwent successful transcatheter closure of PDA without major complications. PAP fell significantly (P<0.05) after device closure of PDA, but mPAP restored to normal level in only 37 patients (33.3%) immediately after PDA closure, and mild, moderate and severe PAH was, respectively, observed in 51, 14 and nine patients. The follow-up period was 1-8 (median 4) years. Twenty-four patients had PAH at 3 months after procedure but only 15 (13.5%) of them had PAH at 6 months, which was persistent during the whole follow up. Device closure resulted in drop in mPAP by (59±10)% in patients without PAH but only (24±14)% in patients with persistent post-procedural PAH (P<0.05). None of the patients with normal PAP and mild PAH but patients with severe PAH after PDA closure before device release had persistent post-procedural PAH. CONCLUSION: In patients with PDA and severe PAH, 13.5% will have persistent post-procedural PAH, although the pre-procedural Qp/Qs ratio is>1.5. Persistent post-procedural PAH will be inevitable in patients with severe PAH immediately after PDA closure and PAH will be persistent if the PAP is still higher than normal 6 months after procedure.

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备注/Memo

备注/Memo:
收稿日期：2014-01-12.
作者简介：张端珍，副主任医师，博士Email：meichengzhang123@163.com
更新日期/Last Update: 2014-07-10