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目的:探讨动脉导管未闭(patent ductus arteriosus,PDA)并发重度肺动脉高压(pulmonary arterial hypertension,PAH)经导管封堵术后肺动脉压力(pulmonary artery pressure,PAP)变化及其与术后PAH的关系。方法:对111例肺动脉平均压(mean pulmonary artery pressure,m PAP)>55 mm Hg,肺/体循环血量比值(Qp/Qs)>1.5的PDA患者实施封堵术,术中实时监测封堵术前后PAP变化,术后定期随访并行超声心动图检查。结果:所有患者均成功实施封堵术,术后即刻PAP显著降低(P<0.05),但m PAP恢复正常仅37例(33.3%),另有轻度、中度和重度PAH患者51(49.5%),14(12.6%)和9例(8.1%)。随访1~8(中位数4)年。术后3个月共24例(21.6%)患者存在PAH,其中9例术后6个月PAP恢复正常,另外15例(13.5%)PAH持续存在。术后PAP最终恢复正常的患者封堵术后即刻m PAP降低(59±10)%,术后存在持续性PAH者仅降低(24±14)%。术后即刻PAP正常和轻度PAH者术后PAP最终均恢复正常,而术后即刻存在重度PAH者随访期间PAH持续存在。结论:在并发重度PAH的PDA患者中,即使Qp/Qs>1.5,仍有13.5%的患者存在术后持续性PAH;关闭PDA后导管测量PAP为重度PAH者,术后PAH不可避免;如果术后6个月PAP仍然高于正常,PAH将持续存在。
OBJECTIVE: To investigate the changes of pulmonary artery pressure (PAP) after catheter closure of patent ductus arteriosus (PDA) complicated with pulmonary arterial hypertension (PAH) and its relationship with postoperative PAH. Methods: A total of 111 PDA patients with mean pulmonary artery pressure (m PAP)> 55 mm Hg and Qp / Qs> 1.5 were enrolled in this study. Real-time monitoring of occlusion PAP changes before and after regular follow-up after echocardiography. RESULTS: The closure of all patients was successfully performed, and PAP immediately after operation was significantly lower (P <0.05), but only mPAP returned to normal in 37 cases (33.3%), and mild, moderate and severe PAH 51 (49.5 %), 14 (12.6%) and 9 patients (8.1%). Follow-up 1 ~ 8 (median 4) years. A total of 24 patients (21.6%) had PAH at 3 months after operation, 9 of whom returned to normal after 6 months and 15% (13.5%) of PAH persisted. Immediately after closure of PAP, patients with PAP eventually returned to normal postoperative m PAP reduction (59 ± 10)%, postoperative persistent PAH decreased only (24 ± 14)%. Postoperative PAP normal and mild PAH after the PAP eventually returned to normal, and immediately after the presence of severe PAH PAH persisted during follow-up. Conclusions: In patients with severe PAH complicated with PAH, persistent postoperative PAH is still present in 13.5% of patients even after Qp / Qs> 1.5. PAH is inevitable in patients with severe PAH after PDA is closed after PDA closure. After 6 months PAP is still above normal, PAH will persist.