儿童先天性心脏病介入治疗436例临床分析

目的总结儿童先天性心脏病介入治疗的临床经验,分析其疗效。方法2007年1月至2013年6月新疆维吾尔自治区人民医院北院共施行0～14岁儿童先天性心脏病介入封堵治疗436例,其中继发孔型房间隔缺损213例,室间隔缺损83例,动脉导管未闭139例,房间隔缺损合并动脉导管1例。房间隔缺损、室间隔缺损及动脉导管未闭封堵术均采用Amplatzer法。结果全组患儿无手术死亡病例,封堵成功423例（97．4％）,房间隔缺损组、室间隔缺损组和动脉导管未闭组的成功封堵率分别为97．7％（208／213）,94．0％（79／83）,98．6％（137／139）。室间隔缺损封堵术后早期心律失常发生率较高（15．2％）。全组门诊心脏超声心动图、心电图、胸部X线片随访3-36个月,无残余分流、死亡及严重心脏事件。结论经导管介入治疗先天性心脏病创伤小、安全、可靠、成功率高,部分患者可替代外科手术。     

介入治疗心脏复合畸形疗效及安全性研究

目的评估介入治疗心脏复合畸形的可行性,安全性及疗效。方法心脏复合畸形患者10（男6,女4）例,年龄5～53岁。其中房间隔缺损（ASD）并发肺动脉瓣狭窄（PS）2例、室间隔缺损（VSD）2例和动脉导管未闭（PDA）1例,PDA并发主动脉瓣关闭不全和PS各1例;VSD修补术后遗留ASD2例,ASD修补术后遗留PDA1例和刀刺伤致左室前侧术后遗留VSD1例。ASD或PDA并发PS者,先扩张肺动脉瓣,再行ASD或PDA封堵治疗。ASD并发VSD者,先封堵VSD,再封堵ASD。结果10例患者介入手术均1次成功。5例ASD封堵器的直径为8～38mm,2例膜部对称性VSD封堵器的直径为14mm和6mm,1例用10mm肌部VSD封堵器。2例PDA均用弹簧圈封堵。封堵PDA或VSD后造影无残余分流。封堵ASD后超声心动图示无残余分流。3例并发PS者,肺动脉瓣扩张术后即刻肺动脉跨瓣压差明显下降,由术前50、38、40mmHg分别降低为20、15和21mmHg。有1例PDA封堵弹簧圈脱落至肺动脉远端未能取出。随访1年肺功能正常,无肺不张。全部患者随访3个月～1年,无任何并发症发生。结论经导管介入治疗心脏复合畸形安全可行,近期疗效肯定。     

小儿先天性心脏病介入治疗302例回顾分析

目的总结先天性心脏病患者介入治疗疗效、并发症情况及预防措施。方法回顾性分析302例行介入治疗的先天性心脏病患儿的临床资料,着重分析治疗疗效及总结并发症的处理经验。本组共302例患儿,男125例,女177例,年龄3个月～14岁,中位年龄4.4岁,体质量(12.8±6.7)kg。其中动脉导管未闭(patent ductus arteriosus,PDA)组183例、房间隔缺损(atrial septal defect,ASD)组69例、室间隔缺损(ventricular septal defect,VSD)组50例,分别行PDA、ASD、VSD堵闭术,术后半年内每个月随访心电图及超声心动图检查1次,半年后每6～12个月复查心电图及超声心动图检查1次。结果 PDA组、ASD组、VSD组的成功封堵率分别为99.4%(182/183),100%(69/69),98%(49/50)。各组术后并发症发生率(术后72h内)分别为2.2%(4/183),4.3%(3/69),10%(5/50)。PDA组183例患儿3例存在残余分流,1例出现溶血;ASD组69例患儿2例存在少量残余分流,1例出现暂时性Ⅱ度房室传导阻滞;VSD组50例患儿1例存在残余分流,1例出现Ⅲ度房室传导阻滞,3例出现完全性右束支传导阻滞。在6个月～3年的随访中,PDA组仅1例有微量残余分流,2例心脏扩大;ASD组无残余分流,Ⅱ度房室传导阻滞转为Ⅰ度房室传导阻滞;VSD组1例有少量残余分流,1例持续存在完全性左束支传导阻滞。结论 PDA及ASD封堵技术成熟,手术效果好,并发症发生率低。VSD封堵术后早期心律失常(术后5d左右)发生率较高,术后持续监测患者心电图的变化非常重要。     

Miscellaneous use of exercise echocardiography in patients with chronic pulmonary disease or congenital heart defect

To date, the usage of exercise echocardiography in patients with pulmonary or congenital heart disease has been limited despite its potential for broader applications in different clinical scenarios. Exercise echocardiography can be utilized to determine the extent of pulmonary vascular damage in patients with chronic obstructive pulmonary disease by demonstrating the presence of exertional pulmonary hypertension in subjects with normal pulmonary artery pressures (PAPs) at rest. It is also useful in patients with connective tissue disease to screen for lung involvement by identifying exertional pulmonary hypertension, and in patients with established pulmonary hypertension to choose and monitor the effects of therapeutic interventions on the PAPs. Moreover, the measurement of aortic flow velocity and acceleration by exercise echocardiography may be helpful in the study of dyspnea in patients at risk for both pulmonary disease and congestive heart failure. In patients with congenital heart disease, the measurement of PAP and ventricular function both at rest and during exercise by echocardiography is the cornerstone in the investigation of the etiology of exercise intolerance in these individuals. Lastly, exercise echocardiography can also screen for residual narrowing in patients after repair of the coarctation of the aorta by detecting a significant diastolic gradient in the descending aorta during exercise provocation.     

应用双封堵器封堵治疗复杂膜部瘤型室间隔缺损

目的:探讨应用双封堵器对复杂膜部瘤型室间隔缺损（VSD）进行介入封堵治疗的可行性、有效性和安全性。方法: 12例复杂膜部瘤型VSD患者,左心室造影后常规右股动脉-左心室-VSD-右心室-右股静脉输送轨道,对VSD进行封堵,重复左心室造影,发现存在不能接受的残余分流,遂建立右股动脉-左心室-VSD-右心室-左股静脉输送轨道,应用第2枚封堵器对残余分流进行封堵,左心室、升主动脉造影以及超声心动图检查确认封堵效果良好,释放封堵器。术后1、3、6、12个月复查超声心动图、X线检查和12导联心电图。结果: 12例患者均封堵成功。术毕即刻造影和超声心动图检查示封堵效果良好,无残余分流,各组瓣膜功能良好,无并发症发生。随访期间所有患者杂音消失,超声心动图检查无残余分流,心电图检查均为窦性心律,无房室传导阻滞或束支传导阻滞。结论: 应用双封堵器对复杂膜部瘤型VSD进行封堵治疗是可行的,且具有满意的疗效和安全性。     

先天性心脏病介入治疗1016例临床疗效分析

目的探讨先天性心脏病介入治疗的临床疗效。方法回顾性分析1016例行先天性心脏病介入治疗的先天性心脏病患者的临床资料,着重分析手术方法和结果。其中动脉导管未闭（PDA）364例,房间隔缺损（ASD）199例,室间隔缺损（VSD）270例,肺动脉瓣狭窄（PS）107例,房间隔缺损合并动脉导管未闭22例,室间隔缺损合并动脉导管未闭11例,肺动脉瓣狭窄合并动脉导管未闭8例,房间隔缺损合并肺动脉瓣狭窄27例,房间隔缺损合并室间隔缺损3例,法洛四联症合并侧支5例。结果技术成功率98．6％（1002／1016）,全组无死亡。随访1～6个月,封堵器位置固定,无移位或破损。结论先天性心脏病介入治疗具有成功率高、创伤小、并发症低,操作简单,疗效确切,恢复快等特点,是治疗先天性心脏病的理想手段之一。     

先天性心脏病介入封堵未成功原因分析

目的：分析先天性心脏病（先心病）介入封堵治疗未成功原因及防治措施。方法：对206例3种常见先心病施行了介入封堵治疗．其中动脉导管未闭（PDA）封堵64例（PDA组）;房间隔缺损（ASD）封堵76例（ASD组）;室间隔缺损（VSD）封堵66例（VSD组）。对介入治疗未成功的7例作了回顾分析。结果：未成功率为3．40％（7／206）。其中PDA组为3．13％（2／64）,ASD组为2．63％（2／76）,VSD组为4．55％（3／66）。未成功原因是：对导管大小判断有误,放置封堵伞有误,输送鞘管引起迷走神经反射。结论：先心病介入封堵术是一种微创、有效的治疗措施,但影响手术成功的因素不容忽视。     

先天性心脏病介入治疗进展

先天性心脏病( congenital heart disease,CHD) ,简称先心病,是胎儿期心脏及大血管发育异常所致的先天性畸形,是小儿最常见的心脏病,也是婴幼儿死亡的主要原因之一。该文就房间隔缺损、室间隔缺损、动脉导管未闭三种我国最常见的先天性心脏病的介入治疗进展进行综述。     

Down综合征并发先天性心脏病的临床分析

目的：总结分析Down综合征（Down’s syndrome）并发的先天性心脏病畸形及血流动力学资料。方法：2008年7月-2012年10月,采用经胸二维超声心动图并彩色多普勒显像及右心导管／心血管造影检查方法,诊断36例并发先心病的Down综合征患者,本文通过36例临床资料分析,探讨Down综合征并发的先心病畸形及其血流动力学。结果：36例患者中室间隔缺损（VSD）10例,房室间隔缺损（AVSD）6例,动脉导管未闭（PDA）6例,房间隔缺损（ASD）2例,ASD＋PDA2例,ASD＋VSD1例,ASD＋PDA＋VSD1例,VSD＋PDA4例,PDA十二叶主动脉瓣（BAV）1例,法洛四联症（TOF）2例,TOF＋ASD1例,18例有肺动脉高压者,其中5例为阻力型肺动脉高压。结论：①Down综合征并发的心血管畸形中,以VSD、AVSD和PDA最为常见,并常并发ASD、TOF。②在无肺动脉狭窄的患者中,约50％并发有肺动脉高压。     

复杂紫绀型先天性心脏病并发体肺侧支的内外科镶嵌治疗

目的:总结并发体肺侧支的复杂紫绀型先天性心脏病内外科镶嵌治疗的临床经验,探讨其治疗意义、操作技术及安全性。方法: 回顾性分析41例并发体肺侧支的复杂紫绀型先心病患者,年龄1～28（15±10）岁,体质量（18±8）kg。均行螺旋CT检查确诊,38例术前封堵侧支血管,3例术前漏诊术后封堵侧支血管。全组均行外科一期矫治手术。结果: 全组治愈37例。死亡4例:1例死于肺部感染,3例死于顽固性心力衰竭。侧支血管直径2.5～9.4（5.3±2.1） mm。每位患者放置弹簧圈3～21（10±6）枚。3例术后因侧支血管再通而二次封堵。术后4例并发肺部感染,3例肺水肿,2例灌注肺。结论: 并发体肺侧支的复杂紫绀型先心病,在围手术期应当内外科联合处理侧支血管的问题。可采用经皮介入封堵法,有效、简单、安全,可行多支、多次封堵,有效减少并发症的发生,降低手术死亡率。     

先天性心脏病并发重度肺动脉高压介入封堵联合伐地那非的应用研究

目的:研究先天性心脏病(CHD)并发重度肺动脉高压(PAH)介入封堵联合盐酸伐地那非综合治疗的应用。方法:术前、后常规给予29例患者口服盐酸伐地那非治疗,对有介入封堵适应证的患者置入封堵器进行试验性封堵测压,若肺动脉压降低幅度为原来压力的20%或下降30mmHg(1mmHg=0.133kPa)以上后进行永久封堵,术后继续采用超声多普勒心动图随访患者肺动脉收缩压(SPAP)、肺循环、体循环收缩压比值(Pp/Ps)、右室大小(RV)、左室射血分数(LVEF)12个月。结果:本组29例患者经术前、后常规予盐酸伐地那非治疗后,27例行介入试验性封堵测压,随后有25例肺动脉压降低幅度为原来压力的20%或下降30mmHg以上。对这25例患者进行永久封堵,且5例使用带孔封堵器,随访12个月,除1例死亡外,其余心功能恢复Ⅰ级以上、动脉血氧饱和度(SaO2)均恢复在0.95以上、SPAP、Pp/Ps、LVEF、RV均有显著改善(均P<0.05)。4例无法封堵的患者除1例转心外科手术后死亡外,其余心功能由Ⅳ级恢复到Ⅲ级、SaO2在0.90以上、动脉血氧分压>60mmHg。结论:介入试验性封堵联合盐酸伐地那非综合治疗微创、简便、安全、可靠,给CHD并发重度PAH的患者带来根治的希望。     

Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults.

More information is needed to clarify whether stenting is superior to balloon angioplasty (BA) for unoperated coarctation of the aorta (CoA). From September 1997, 21 consecutive adolescents and adults (24 +/- 11 years) with discrete CoA underwent stenting (G1). The results were compared to those achieved by BA performed in historical group of 15 patients (18 +/- 10 years; P = 0.103; G2). After the procedure, systolic gradient reduction was higher (99% +/- 2% vs. 87% +/- 17%; P = 0.015), residual gradients lower (0.4 +/- 1.4 vs. 5.9 +/- 7.9 mm Hg; P = 0.019), gain at the CoA site higher (333% +/- 172% vs. 190% +/- 104%; P = 0.007), and CoA diameter larger (16.9 +/- 2.9 vs. 12.9 +/- 3.2 mm; P < 0.001) in G1. Aortic wall abnormalities were found in eight patients in G2 (53%) and in one in G1 (7%; P < 0.001). There was no major complication. Repeat catheterization (n = 33) and/or MRI (n = 2) was performed at a median follow-up of 1.0 year for G1 and 1.5 for G2 (P = 0.005). Gradient reduction persisted in both groups, although higher late gradients were seen in G2 (median of 0 mm Hg for G1 vs. 3 for G2; P = 0.014). CoA diameter showed no late loss in G1 and a late gain in G2 with a trend to being larger in G1 (16.7 +/- 2.9 vs. 14.6 +/- 3.9 mm; P = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in G1. Aortic wall abnormalities did not progress and one patient required redilation in G2. Blood pressure was similar in both groups at follow-up (126 +/- 12/81 +/- 11 for G1 vs. 120 +/- 15/80 +/- 10 mm Hg for G2; P = 0.149 and 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, stenting was a better means to relieve the stenosis and minimize the risk of developing immediate aortic wall abnormalities.     

Interventional treatment for congenital heart disease and its severe complications

Background To approach the incidence, cause and possible treatment of severe complications induced during or after congenital heart disease interventions. Methods Interventional procedures of congenital heart disease were performed in 654 patients from January 2003 to October 2009, which were divided into four groups, i.e. patent ductus arteriosus （PDA）, atrial septum defect （ASD）, pulmonary stenosis（PS）, ventricular septum defect（VSD）, among them 32 patients with severe complications were retrospectively analyzed. Results A total of 654 cases accepted the treatment of intrusion. There was one death in all the patients, ten patients failed in the operation. The overall severe complication rate was 4.89% （32/654）, in which 2.29%（4/175） in PDA group, 5.26%（10/190） in ASD group, 5.77% （3/52） in PS group, 6.33%（15/237） in VSD group, respectively. Conclusions The severe complication rates of interventional therapy for congenital heart disease are low, it is a relatively safe interventional method, and careful supervision is necessary during or after procedure.     

Endovascular stents for treatment of coarctation of the aorta: Acute results and follow‐up experience

Balloon angioplasty as treatment for coarctation of the aorta is increasingly performed. Endovascular stents have been proposed as a means of improving the efficacy and safety of the procedure. In this report, we describe one institution's immediate results and clinical follow‐up after implantation of endovascular stents. Retrospective analysis for endovascular stent placement for coarctation of the aorta between 1993 and 2002 was made. The immediate hemodynamic results and clinical follow‐up were reviewed. Thirty‐two patients underwent attempted stent placement for coarctation. Twenty‐three patients had postoperative recurrent coarctation and nine had native coarctation. The systolic gradient decreased from 31 to 1.8 mm Hg (P = 0.001) and the diameter was increased 8.1 to 13.5 mm (P–0.001). Mean follow‐up was 1.5 years. The mean follow‐up gradient as assessed by sphygomomanometry was 13.1 mm Hg. Eight patients underwent 10 successful further dilations. Complications included one stent migration and one aortic dissection. The use of stents as an adjunct to balloon angioplasty in selected patients with coarctation can be performed with low complication rates and provides excellent immediate relief of obstruction with promising follow‐up. Further dilation of these stents is possible. Long‐term follow‐up is warranted. Catheter Cardiovasc Interv 2004;62:499–505. © 2004 Wiley‐Liss, Inc.     

New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease.

OBJECTIVES: To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques. BACKGROUND: For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective. METHODS: Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum. RESULTS: The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth. CONCLUSIONS: Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.     

介入治疗巨大房间隔缺损的临床研究

目的:评价应用Amplatzer ASD封堵器介入治疗巨大房间隔缺损(ASD)的疗效。方法:所有患者均在X线透视和经胸超声心动图(TTE)监测下,按照TTE所测的ASD最大伸展直径加4~8mm或者按所选封堵器周径﹥ASD周径的1/8~1/10选择Amplatzer ASD封堵器,操作采用"心房法"。术后随访行TTE、胸X片线及心电图检查,观察Amplatzer ASD封堵器的位置、形状及与相邻瓣膜的关系,了解肺血及心胸比例的情况,以评价其疗效及安全性。结果:63例ASD中,60例封堵成功,成功率为95.2%。术后即刻行TTE检查有6例存在少量残余分流,均于术后72h~3个月内消失;18例合并肺动脉高压患者术后3个月肺动脉压力均有不同程度下降;52例合并三尖瓣关闭不全及16例合并二尖瓣关闭不全患者术后3个月均有不同程度好转;早期有7例患者出现阵发性室上性心律失常,于出院前全部自行消失;术前8例心房颤动者术后有4例转为窦性心律;术前13例患者合并有完全或不完全性右束支传导阻滞,9例消失于术后6个月内,其余4例成为永久性。所有患者X线平片显示:肺血不同程度减轻,心胸比例不同程度缩小。所有成功封堵患者术后封堵器无组织反应、无金属反应,封堵器位置准确稳定,装置无变形及折断,无血栓形成及溶血等严重并发症的发生。结论:应用Amplatzer ASD封堵器封堵巨大ASD是安全的,有效的,但在操作中应注意防止封堵器脱落并发症的发生。     

Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up

OBJECTIVES—To test the hypothesis that endovascular stents used with dilation of coarctation of the aorta (CoA) improve late outcomes. Balloon dilation for CoA has been limited by concerns over the risk for acute dissection, late restenosis, or aneurysm formation.
DESIGN—All patients seen with CoA between November 1994 and September 1997 underwent attempted stent implantation. Follow up was obtained for all patients and a subgroup (n = 18) had repeat catheterisation at a mean (SD) of 1.3 (0.5) years to assess residual gradient and stent-CoA morphology.
RESULTS—Stents were placed in 27 patients (15 male and 12 female patients, mean age 30.1 (13.1) years), of whom seven had prior surgical coarctectomy and one had a prior balloon dilation. Hypertension was present in 26 patients (mean pressure 164 (26)/86 (13) mm Hg), of whom 16 were on antihypertension drugs. CoA gradients were 46 (20) mm Hg (range 18-106 mm Hg) at baseline and 3 (5) mm Hg after the procedure. One patient had a stroke following the procedure; another patient had incomplete dilation and underwent a second procedure. At 1.8 (1) years after the procedure the mean pressure was 130 (14)/74 (11) mm Hg with seven patients on antihypertension treatment. The clinical gradient was 4 (8) mm Hg (range 0-32 mm Hg). At follow up angiography, the mean gradient was 4(6) mm Hg, and two patients had a gradient over 10 mm Hg. Aneurysms formed in three patients at the dilation site; one patient was referred for surgery.
CONCLUSION—In this age group stent management for CoA appears to be an effective technique and results in sustained reduction in CoA gradients at early term follow up, but aortic aneurysm was detected in 17% of patients who had repeat angiography.


Keywords: angioplasty; coarctation of the aorta; congenital heart defects; stents     

同期介入治疗先天性心脏病复合畸形30例的疗效观察

目的探讨经导管同期介入治疗先天性心脏病复合畸形的方法及疗效。方法先心病复合畸形30例,男性14例,女性16例,平均年龄（17．9±13．5）岁,平均体重（38．8±22．0）kg。复合类型为：房间隔缺损（ASD）并动脉导管未闭（PDA）7例,ASD并室间隔缺损（VSD）10例,ASD并肺动脉瓣狭窄（PS）6例,VSD并PDA5例,PDA并PS1例,VSD并PDA并ASD1例。经导管治疗原则：先行瓣膜球囊扩张术纠正瓣膜狭窄,其次行VSD封堵术,再行PDA封堵术,最后行ASD封堵术,可根据具体情况相应调整。术后2d、1个月、3个月、6个月、1年复查超声心动图及心电图。结果30例复合型先天性心脏病患者均一次治疗成功。7例合并PS患者,跨肺动脉瓣压差由术前（46．1±15．1）mmHg下降到术后（17．6±3．8）mmHg（P〈0．01）,1例室间隔缺损术后心电图提示不完全右束支传导阻滞,1例室间隔缺损术后心电图提示完全右束支传导阻滞,1例室间隔缺损术后心电图提示不完全左束支传导阻滞,给予地塞米松治疗后,心电图复查正常。1例VSD并ASD患者术前心电图提示双束支传导阻滞,术后观察10d仍存在,给予置人心脏永久起搏器。2例VSD并PDA患者术后超声心动图提示心室水平微量分流,6个月时随访分流消失。所有患者随访无不良并发症发生。结论对先天性心脏病复合畸形,严格掌握介人治疗适应证,选择正确的操作顺序和方法,可以取得良好的效果。     

老年肺栓塞临床特点及介入溶栓疗效观察

目的探讨老年肺栓塞的临床特点及介入溶栓治疗的效果。方法回归性分析39例年龄60岁以上肺栓塞患者临床表现、实验室检查、影像学资料及介入溶栓治疗和转归。比较急性肺栓塞组和亚急性肺栓塞组疗效差异。结果所有39例患者均合并有一种或一种以上基础疾病,其中高血压（53.8%）及糖尿病（38.5%）最为常见。临床表现主要为呼吸困难92.3%（36/39）、咳嗽41.1%（16/39）和胸痛38.5%（15/39）。主要体征为双下肢不对称性肿胀46.2%（18/39）及低血压41.1%（16/39）。39例患者均进行介入溶栓治疗,急性肺栓塞组27例,治愈16例,显效7例;亚急性肺栓塞组12例,治愈3例,显效5例。急性组疗效优于亚急性组（有效率85.18%VS 66.7%,P〈0.05）,治疗中未有出血现象。结论老年肺栓塞患者临床表现不典型,易被误诊为其他疾病。老年肺栓塞患者介入溶栓治疗安全有效,溶栓治疗越早越好,即使是亚急性肺栓塞介入溶栓治疗仍有效。     

动脉导管未闭并重度肺动脉高压封堵术后肺动脉压力变化

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(P0.05),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/Qs1.5,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。