摘要
目的评估经导管封堵治疗成人动脉导管未闭(PDA)合并重度肺动脉高压(PH)的即刻和短期疗效。方法应用Amplatzer PDA封堵伞和国产封堵器对28例患者进行试封堵,术后1d、1、3和6个月复查X线胸片、心电图和超声心动图。结果20例封堵有效,释放封堵伞,8例封堵无效收回封堵伞。在20例有效封堵组中,PDA最窄直径为(10.4±2.7)mm,所选择的封堵伞肺动脉端直径为(15.6±3.2)mm。吸氧前后股动脉血氧饱和度分别为(93.5±1.8)%、(98.2±1.8)%(P<0.01)。封堵前后肺动脉收缩压分别为(95.5±24.1)、(56.3±18.3)mm Hg(1mm Hg=1.33kPa)(P<0.01);肺动脉平均压分别为(70.8±18.2)、(41.0±13.8)mm Hg(P<0.01)。6个月后复查超声心动图示左房、左室和主肺动脉直径明显缩小,仅1例例外;X线胸片示肺血有所减轻、心脏缩小,心胸比率从(59.2±6.6)%减少到(54.2±3.3)%(P<0.01)。8例放弃封堵者,4例临床可见明显分界性紫绀,封堵前后肺动脉收缩压分别为(110.3±13.9)、(139.5±20.0)mm Hg(P<0.01);主动脉收缩压分别为(116.0±20.2)、(106.3±16.9)mm Hg(P<0.05)。其余4例患者2例试封堵后残存大量分流,2例出现头晕和胸闷等症状。结论经导管封堵合并重度肺动脉高压的成人PDA是一种安全有效的理想方法。
Objective To evaluate the effect of self-expandable occluder on closure of patent ductus arteriosus （PDA） with severe pulmonary arterial hypertension （PH） in adults. Methods Twenty-eight adult patients underwent transcatheter closure of PDA at a mean age of （ 31.3 ± 11.6 ） years [ （ 18-58 ） years]. Either Amplatzer duct occluder or domestic device was used in the present study. X-ray, EKG and UCG were repeated in one day, one month, three months, and six months. Results Twenty of the 28 patients had successful occlusion, and the other 8 patients were given up. In the successful group, the narrowest diameter of PDA was （ 10.4 ±2.7） mm [ （6-16） mm], the diameter of selected oceluder was （15.6 ± 3.2） mm [ （10-20） mm ] at the end of pulmonary artery. Systemic artery oxygen saturation （SAsat） before and after oxygen inhalation was （93.5 ± 1.8）%, （98.2 ± 1.8）%, respectively （P 〈0. 01 ）. Systolic pulmonary arterial pressure decreased significantly after trial occlusion from （95.5 ± 24.1） mm Hg to （56.3 ± 18.3） mm Hg （P 〈 0.01）; Mean pulmonary arterial pressures decreased significantly from （70. 8 ± 18.2） mm Hg to （41.0 ± 13.8 ） mm Hg （ P 〈 0. 01 ）, too. Six months later UCG showed that the dimensions of left atrium, left ventricle and pulmonary artery attenuated significantly with one exception; X rays showed decreased pulmonary vascularity or cardiac size as well [ cardio-thoracic ratio： （59.2±6.6）% vs （54.2 ±3.3）%, P 〈0.01]. In given up group, four patients were defined as Eisenmenger syndromes with differential cyanosis. They presented with elevated systolic pulmonary arterial pressure [（110.3±13.9） mm Hg vs （139.5 ±20.0）mm Hg, P〈0.01], or decreased systolic aortic pressure[（116.0±20.2） mm Hg vs （106.3 ± 16.9） mm Hg, P 〈0.05] after occlusion. The others included two cases with large residual shunt, and two cases with worsening of symptoms . Conclusions Transcatheter closure of PDA with reversib
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2006年第11期1185-1189,共5页
Chinese Journal of Radiology
关键词
动脉导管未闭
放射学
介入性
Patent ductus arteriosus
Radiology,interventional
