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目的:高原地区应用主动脉覆膜支架腔内隔绝治疗成人巨大动脉导管未闭(PDA)合并重度肺动脉高压(SPH)并对其疗效进行评价。方法:分析2010年9月—2011年8月在我院接收主动脉覆膜支架隔绝治疗的8例(男5例,女3例)巨大PDA成人患者临床资料。患者年龄19岁～45岁,平均(30.3±9.4)岁,主动脉造影示PDA最窄径为(18～28)mm,平均(21±3)mm。肺动脉收缩平均压(76.6±9.4)mmHg。术后随访(6～18)个月,平均(9.8±2.1)个月。结果:8例患者行PDA球囊试封堵,证实为动力性肺动脉高压。8例均隔绝成功,术后造影显示6例动脉导管完全封闭,2例残余少量左向右分流。术后2周超声心动图及大血管CT血管造影(CTA)示残余分流消失,肺动脉收缩压平均(43.5±7.2)mmHg。1例术后右下肢深静脉血栓形成,经对症治疗后好转。1例出现左侧上肢肌力下降,2周后恢复。结论:应用主动脉覆膜支架腔内隔绝治疗成人巨大PDA是一种安全有效的方法。
OBJECTIVE: To evaluate the efficacy of aortic stent-graft in the treatment of adult giant patent ductus arteriosus (PDA) combined with severe pulmonary hypertension (SPH) in the plateau. Methods: The clinical data of 8 adults (5 males and 3 females) receiving huge aorta stents in our hospital from September 2010 to August 2011 were analyzed. The patients were 19 to 45 years old with an average of (30.3 ± 9.4) years. The narrowest diameter of aorta was (18-28) mm and averaged (21 ± 3) mm. Pulmonary artery contraction average pressure (76.6 ± 9.4) mmHg. The patients were followed up for 6-18 months, with an average of (9.8 ± 2.1) months. Results: Eight patients underwent PDA balloon blockade test, confirmed as pulmonary hypertension. 8 cases were isolated successfully, postoperative angiography showed complete closure of 6 cases of ductus arteriosus, 2 cases left a small amount of left to right shunt. Echocardiography and large-vessel CT angiography (CTA) showed that residual shunt disappeared 2 weeks after operation, and systolic pulmonary pressure was (43.5 ± 7.2) mmHg on average. One case had deep venous thrombosis in the right lower extremity after operation and was improved after symptomatic treatment. In one case, left upper limb muscle strength decreased and recovered after 2 weeks. Conclusion: The application of aortic stent-graft for the treatment of giant PDA in adults is a safe and effective method.