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目的评价带孔(8 mm)房间隔缺损封堵器(ASO)治疗房间隔缺损(ASD)合并重度肺动脉高压(PAH)的疗效。方法选取沈阳军区总医院2002年9月至2013年4月收治的17例(男1例,女16例)ASD合并重度PAH患者,采用带孔ASO行介入封堵,术后随访时间为1.5~12(6.4±2.7)年,收集肺动脉压(PAP)、右心室舒张末期内径(RVEDd)、左心室舒张末期内径(LVEDd)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)和左心室射血分数(LVEF)。结果封堵前右心导管检查肺动脉收缩压(s PAP)60~108(88.7±11.7)mm Hg(1 mm Hg=0.133 k Pa),平均肺动脉压(m PAP)29.3~60(51.0±8.1)mm Hg,肺循环血流量/体循环血流量(Qp/Qs)1.50~2.44(1.8±0.31),肺血管阻力(PVR)3.1~9.7(5.6±1.5)wood。置入带孔ASO直径为30~42(36±4.9)mm,封堵后s PAP 56~99(70±11.5)mm Hg,m PAP 27~51.7(41.1±7.1)mm Hg,较术前均有显著下降(P<0.05)。术后3 d和3、6个月RVEDd缩小(P<0.05),LVEDd、LVEDV、LVEF均增大(均P<0.05)。术后3、6个月的s PAP分别为50~78(61.6±7.5)mm Hg和46~68(55.9±5.7)mm Hg,较术前均有显著下降(均P<0.05);中远期s PAP为45~100(60.2±13.3)mm Hg,较封堵前显著下降(P<0.05),但与术后6个月比较,差异无统计学意义(P>0.05)。结论采用带孔ASO封堵ASD合并重度PAH效果较好,是治疗ASD合并重度PAH的理想方法。
Objective To evaluate the efficacy of ventricular septal defect occluder (ASO) with aorta (8 mm) in the treatment of atrial septal defect (ASD) complicated with severe pulmonary hypertension (PAH). Methods 17 patients (1 males and 16 females) with ASD complicated with severe PAH admitted to Shenyang Military Region General Hospital from September 2002 to April 2013 were enrolled in the study. The patients were followed up for 1.5 ~ Pulmonary arterial pressure (PAP), right ventricular end diastolic dimension (RVEDd), left ventricular end diastolic dimension (LVEDd), left ventricular end-diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) And left ventricular ejection fraction (LVEF). Results The pulmonary artery systolic pressure (s PAP) was 60 ~ 108 (88.7 ± 11.7) mm Hg (1 mm Hg = 0.133 kPa) and mean pulmonary artery pressure (m PAP) 29.3 ~ 60 (51.0 ± 8.1) mm Hg, pulmonary circulation blood flow / systemic circulation blood flow (Qp / Qs) 1.50 ~ 2.44 (1.8 ± 0.31) and pulmonary vascular resistance (PVR) 3.1 ~ 9.7 (5.6 ± 1.5) wood. The diameter of ASO was 30 ~ 42 (36 ± 4.9) mm and s PAP 56 ~ 99 (70 ± 11.5) mm Hg, mb 27 ~ 51.7 (41.1 ± 7.1) mm Hg after occlusion, There was a significant decrease (P <0.05). The RVEDd decreased (P <0.05) and LVEDd, LVEDV and LVEF increased at 3 d and 3 and 6 months postoperatively (all P <0.05). The s PAP at 3 and 6 months postoperatively were 50-78 (61.6 ± 7.5) mm Hg and 46-68 (55.9 ± 5.7) mm Hg respectively, both significantly lower than those preoperatively (all P <0.05). COSCO The PAP was 45 ~ 100 (60.2 ± 13.3) mm Hg, which was significantly lower than that before occlusion (P <0.05), but no significant difference was found between the two groups at 6 months after operation (P> 0.05). Conclusion It is better to block ASD with severe PAH by perforated ASO, which is an ideal method for treating ASD combined with severe PAH.