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目的 :应用 Amplatzer封堵器经导管治疗动脉导管未闭 (PDA)并发重度肺动脉高压 (SPH) ,并对其疗效进行评价。方法 :全组 15例 ,年龄 2 5± 2 2 (5～ 54)岁。PDA最窄处直径为 11± 4(8～ 18) mm。 PDA 8例采用 AmplatzerPDA封堵器治疗 ,7例采用 Amplatzer房间隔缺损封堵器治疗。封堵后 3 0 min行侧位降主动脉造影 ,术后 1d及 1月行超声心动图检查 ,观察有无残余分流及 PDA再通。结果 :14例 (93 ) %封堵后 3 0 min至 1h肺动脉收缩压由 90～ 150 (10 6± 2 7) mm Hg降至 45～ 110 (65± 2 1) mm Hg,肺动脉平均压由 60～ 10 5(82± 2 1) mm Hg降至 2 6～ 65(50± 19) mm Hg。 1例封堵后 3 0 min至 1h肺动脉收缩压无下降 ,反而有轻度上升 ,考虑为阻力性重度肺动脉高压 ,撤出封堵器。 6例主动脉压力有不同程度增高。术后 3 0 min降主动脉造影示 ,5例存在微至少量残余分流 ,10例封堵完全无残余分流。在术后 2 4h2例仍存在微至少量残余分流 ,其中 1例并发溶血 ,48h后行外科 PDA缝合术。其余病例术后 1月超声心动图检查未见残余分流及再通。结论 :应用 Amplatzer封堵器治疗 PDA并发 SPH是一种安全有效的介入方法
OBJECTIVE: To evaluate the efficacy of Amplatzer occluder for the treatment of patent ductus arteriosus (PDA) complicated with severe pulmonary hypertension (SPH) by catheterization. Methods: The whole group of 15 cases, age 25 ± 2 2 (5 ~ 54) years old. PDA narrowest diameter of 11 ± 4 (8 ~ 18) mm. Eight cases of PDA were treated with Amplatzer PDA occluder and seven cases were treated with Amplatzer atrial septal defect occluder. Lateral descending aorta angiography was performed 30 minutes after occlusion, and echocardiography was performed on the 1st day and the 1st day after operation to observe the presence of residual shunt and PDA recanalization. Results: The pulmonary artery systolic pressure decreased from 90 ~ 150 (106 ± 27) mm Hg to 45 ~ 110 (65 ± 21) mm Hg in 30 (93%) of the 14 patients 60 ~ 105 (82 ± 21) mm Hg to 26 ~ 65 (50 ± 19) mm Hg. One case of occlusion 30 min to 1 h pulmonary artery systolic pressure without decline, but a slight increase, consider the resistance of severe pulmonary hypertension, withdrawal occluder. 6 cases of aortic pressure increased in varying degrees. At 30 min after descending aorta angiography showed that there were 5 micro-minimal residual shunt, 10 cases completely without residual shunt. At 24 hours after operation, there were still at least 2 micro-residual shunts, of which 1 case complicated with hemolysis and underwent surgical PDA suture 48 hours later. The remaining cases after January echocardiography showed no residual shunt and recanalization. Conclusions: Amplatzer occluder is a safe and effective method for the treatment of PDA complicated with SPH