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目的评价经导管封堵术治疗动脉导管未闭伴重度肺动脉高压病人的临床疗效与安全性。方法选择在我院接受经导管封堵术治疗且肺动脉收缩压在80mmHg或以上,肺动脉平均压在60mmHg或以上的动脉导管未闭病人31例,回顾性分析病人术中及术后随访资料。结果31例病人术前肺动脉收缩压80～183(112±28)mmHg,肺动脉平均压63～130(82±22)mmHg。其中30例经导管封堵成功(成功率97%),1例巨大型动脉导管未闭因无合适封堵器而行手术治疗。封堵后10min,26例肺动脉收缩压下降30mmHg以上,2例肺动脉收缩压下降20%以上,另2例肺动脉收缩压无明显改变。1例用房间隔缺损封堵器封堵巨大型动脉导管未闭,在术后3d复查心脏超声时发现封堵器脱入肺动脉而转入外科手术治疗;在5例双向分流者中,1例于术后2个月因重度肺部感染死亡,1例于封堵后血氧饱和度明显增加,但肺动脉压无明显下降,术后2年出现右心功能不全表现。结论动脉导管未闭伴重度肺动脉高压病人,若心脏超声检查示左向右分流,可用经导管封堵术进行根治;但若为双向分流时,经导管封堵治疗应慎重。
Objective To evaluate the clinical efficacy and safety of transcatheter closure of patients with patent ductus arteriosus and severe pulmonary hypertension. Methods Thirty-one cases of patent ductus arteriosus undergoing catheter closure in our hospital with pulmonary artery systolic pressure of 80mmHg or above and pulmonary artery average pressure of 60mmHg or above were retrospectively analyzed, and the data of intraoperative and postoperative follow-up were retrospectively analyzed. Results The preoperative pulmonary artery systolic pressure in 31 patients was 80-183 (112 ± 28) mmHg and the mean pulmonary artery pressure was 63-130 (82 ± 22) mmHg. Thirty cases were successfully treated by catheterization (success rate was 97%). One case of huge patent ductus arteriosus was surgically treated without suitable occluder. In 10 minutes after occlusion, systolic blood pressure of 26 pulmonary arteries decreased more than 30mmHg, systolic blood pressure of pulmonary arteries decreased more than 20% in 2 cases, and systolic pressure of pulmonary arteries did not change obviously in the other 2 cases. 1 case of atrial septal defect occluder occlusion huge patent ductus arteriosus, 3d after review of cardiac ultrasound found that the occluder removed into the pulmonary artery and transferred to surgical treatment; in 5 cases of bidirectional shunt, 1 case At 2 months after operation, the patient died of severe pulmonary infection. In one case, blood oxygen saturation increased significantly after occlusion, but pulmonary arterial pressure did not decrease significantly. Right ventricular dysfunction occurred 2 years after operation. Conclusion Patent ductus arteriosus with severe pulmonary hypertension patients, if left to right shunt echocardiography can be treated with catheterization for radical surgery; but if the two-way shunt, transcatheter closure therapy should be cautious.