覆膜支架在成人动脉导管未闭合并肺动脉高压的临床应用

目的 总结覆膜支架治疗成人动脉导管未闭合并肺动脉高压的体会.方法 2005年9月至2007年3月,4例成人动脉导管未闭合并肺动脉高压病例应用覆膜支架封堵,均为女性,年龄18～42岁,平均(31.5±5.4)岁.动脉导管平均直径(28.3±0.8)mm,肺动脉收缩压平均(66.0±8.3)mmHg.术后随访3～18个月,平均(10.5±1.5)个月.结果 术后造影示3例动脉导管完全封闭,1例残余少量左向右分流.术后2周超声心动及大血管CT示残余分流消失,肺动脉收缩压平均(40.5±7.5)mmHg.4例术后平稳,临床症状缓解.结论 覆膜支架治疗成人动脉导管未闭合并肺动脉高压近期效果良好,是一种可选择的治疗方法.

Closure of large patent ductus arteriosus with pulmonary hyqertension in adults with stent-graft

Objective Patent ductus arteriosus (PDA) is me of the most common congenital heart defects.Because of the fragility of the aorta,surgical closure of PDA carries a higher risk in adults.Our preliminary experience of using stent-gtaft to close large PDA in adults was reported.Methods From Sept.2005 to Mar.2007,four adult patients with large PDA and pulmonary hypertension underwent stent-graft implantation.All patients were female.The average age was (31.5 ±5.4) years (ranging from 18 years to 42 years).The average diameter of PDA was (28.3 ±0.8) mm with main pulmonary artery pressure of (66.0 ±8.3) mm Hg.All patients were followed from 3 to 18 months (average 10.5 months).The clinical data were analyzed.Results Completely occlusion of PDA was achieved in 3 cases immediately after stent-graft implantation.Trivial left to right shunt remained in 1 case.It disappeared two weeks later by tests of echocardiography and CT examination.Mean pulmonary artery pressure decreased (40.5 ±7.5) mm Hg.Postoperative course was uneventful and symptoms disappeared during the follow-up period.Conclusion Early results of endovascular repair of PDA with stent-graft are encouraging.Stent-graft implantation may be a therapeutic alternative for certain adult patients with a large PDA with pulmonary hypertension.