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目的:评价国产封堵器介入治疗合并重度肺动脉高压的成人动脉导管未闭(PDA)的安全性和长期疗效。方法:应用国产PDA封堵器对31例合并重度肺动脉高压的成年PDA患者行封堵治疗,所有患者在术前、术后1d进行详细体检并行12导联心电图(ECG)、X线胸片和经胸超声心动图(TTE)检查,术后进行定期随访。结果:31例患者中成功封堵26例,5例试封堵后证实肺动脉高压为阻力型而收回封堵器。26例成功封堵患者中,PDA直径(12.11±4.12)mm,所选封堵器直径(17.54±4.28)mm。封堵后即刻肺动脉收缩压由(101.92±24.86)mmHg(1mmHg=0.133kPa)降至(64.96±26.33)mmHg,肺动脉平均压由(75.54±16.16)mmHg降至(44.88±19.30)mmHg。少量残余分流3例,微量穿隔血流1例。术后平均随访(39±17.4)个月,心功能明显改善(2.62±0.64vs1.92±0.39),复查X线胸片示心胸比有所缩小;TTE改变主要是左心和主肺动脉直径缩小及射血分数提高,2例仍存在少量残余分流。结论:应用国产封堵器治疗合并重度肺动脉高压的成人PDA安全有效,但必须严格掌握手术适应证。
OBJECTIVE: To evaluate the safety and long-term efficacy of home-made occluder in the treatment of adult patent ductus arteriosus (PDA) complicated with severe pulmonary hypertension. Methods: 31 cases of adult PDA with severe pulmonary hypertension were treated by PDA occlusion device. All patients underwent detailed examination 1 d before operation and 12 days after operation. ECG, X-ray, Transthoracic echocardiography (TTE) examination, regular follow-up after surgery. Results: Twenty-six patients were successfully blocked in 31 patients, and 5 patients were confirmed as pulmonary artery hypertension by blocking after occlusion. Of the 26 patients successfully occluded, PDA diameter (12.11 ± 4.12) mm and diameter of occluder selected (17.54 ± 4.28) mm. Immediate pulmonary artery systolic pressure immediately after occlusion decreased from (101.92 ± 24.86) mmHg (1mmHg = 0.133kPa) to (64.96 ± 26.33) mmHg, mean pulmonary artery pressure decreased from (75.54 ± 16.16) mmHg to (44.88 ± 19.30) mmHg. A small amount of residual shunt in 3 cases, trace through blood flow in 1 case. After an average follow-up of 39 ± 17.4 months, the cardiac function improved significantly (2.62 ± 0.64 vs 1.92 ± 0.39). The chest X-ray examination showed a reduction in cardiothoracic ratio. The changes of TTE were mainly the decrease of diameter of the left heart and the main pulmonary artery And ejection fraction increased in 2 cases there is still a small amount of residual shunt. Conclusion: It is safe and effective to use domestic occluder to treat adult PDA with severe pulmonary hypertension. However, surgical indications must be strictly controlled.