摘要
目的 探讨支架术治疗心房颤动射频消融术后严重肺静脉狭窄的可行性、安全性和有效性.方法 入选2010年4月至2013年4月在上海交通大学附属胸科医院经CT血管成像证实的心房颤动射频消融术后严重肺静脉狭窄患者5例,进行回顾性分析.其中,男性3例,女性2例;年龄（54.1±11.2）岁.对肺静脉选择性造影后,在严重狭窄处置入支架,术后对手术效果进行评估.结果 严重狭窄的14支肺静脉均置入裸金属支架,支架直径7或8 mm,长度12 ～ 23 mm.支架置入后,肺静脉狭窄程度从（83±16）％减至（12±4）％（P＜0.01）,肺静脉最窄段直径从（1.7±0.6） mm扩大至（8.1 ±0.7）mm（P ＜0.01）,跨狭窄压力阶差由（15 ±5）mmHg（1 mmHg =0.133 kPa）下降至（3±2） mmHg（P＜0.05）,肺动脉平均压由（47 ±5） mmHg下降至（28 ±4） mmHg（P ＜0.05）,患者气促缓解.未出现操作相关的严重并发症.术后6个月,3例患者再次出现轻至中度气促,CT血管成像证实其中7支肺静脉内的支架发生再狭窄,经球囊扩张后支架内无残余狭窄.结论 支架术治疗心房颤动射频消融术后严重肺静脉狭窄可能安全、可行,能改善血液动力学,缓解症状;支架内再狭窄发生率较高,应置入大内径支架,并早期介入干预.
Objective To evaluate the feasibility,safety,and effectiveness of pulmonary vein stenting in patients with severe puhnonary vein stenosis （PVS） after catheter ablation of atrial fibrillation （AF）.Methods This retrospective analysis included 5 PVS patients （3 males,（54.1 ± 11.2） years old） confirmed by computed tomography angiography after catheter ablation of AF in Shanghai Chest Hospital from April 2010 to April 2013.After selective pulmonary vein angiography,stents were implanted in the pulmonary vein.Operation results were analyzed after the procedure.Results All of 14 serious pulmonary vein stenosis from these 5 patients were treated with primary stent implantation （diameter：7 or 8 mm,length：12-23 mm）.After stenting,degree of pulmonary vein stenosis decreased from（83 ± 16） % to（12 ± 4） % （P 〈 0.01）,the minimal diameter of the stenosis was significantly increased from （1.7 ± 0.6）mm to （8.1 ± 0.7） mm （P 〈 0.01）,trans-stenotic gradient decreased from （15 ± 5） mmHg （1 mmHg =0.133 kPa） to（3 ± 2）mmHg（P 〈 0.05）,mean pulmonary pressure measured by cardiac catheter decreased from （47 ± 5） mmHg to （28 ± 4） mmHg （P 〈 0.05）.Dyspnea was improved after the procedure.There was no serious operation related complications.Six months after stenting,three patients still complained mild to moderate dyspnea,and in-stent restenosis was evidenced in seven pulmonary veins by computed tomography angiography.These stenosis was successfully dilated by repeated interventions with balloon dilation.Conclusions Stenting for severe pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation may be feasible and safe,and can improve hemodynamics and symptoms.In-stent stenosis is relatively frequent,and larger stents and early intervention may reduce the rates of in-stent restenosis.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2014年第10期827-830,共4页
Chinese Journal of Cardiology
关键词
支架
肺静脉
心房颤动
导管消融术
Stents
Pulmonary veins
Atrial fibrillation
Catheter ablation
