动脉导管未闭合并重度肺动脉高压Amplatzer法封堵治疗的临床应用--12例初步报告

目的评价Amplatzer封堵器治疗动脉导管未闭(PDA)合并重度肺动脉高压(SPH)的初步疗效.方法对12例(女9例,男3例)PDA合并SPH患者实施封堵治疗.其中10例采用Amplatzer动脉导管未闭封堵器,2例采用Amplatzer房间隔缺损封堵器.结果全组12例PDA封堵器均放置成功.11例PDA封堵后30分至1小时肺动脉收缩压、肺动脉平均压均明显降低.1例封堵术后即刻肺动脉压无变化.术后36小时彩色多普勒估测肺动脉压明显下降,封堵术后30分降主动脉造影,无残余分流9例,微量残余分流2例,少量残余分流1例.全组术后24～48小时彩色多普勒检查,动脉水平左向右分流均完全消失.无重要并发症发生.随访1～24个月(平均8个月),患者症状改善,11例心脏缩小,无1例发生再通.结论采用Amplatzer法封堵治疗PDA合并SPH,近期疗效满意.

Transcatheter Closure of Patent Ductus Arteriosus with Severe Pulmonary Hypertensionby Amplatzer Occluder: A Preminary Report of 12 Cases

Objective: To evaluate the immediate and short-term effectiveness of transcatheter closure of patent ductus arteriosus (PDA)with severe pulmonary hypertension (SPH)using Amplatzer duct occluder (ADO)device and Amplatzer septal occluder (ASO)device. Methods: Twelve patients suffering from PDA with SPH were treated by transcatheter closure with ADO in 10 patients and ASO in 2 patients. Aortography was repeated 30 minutes after the closure to assess the degree of residual shunt and confirm the device position. Once of the device was found to be in a satisfactory position and no or only a trace or small residual shunt was confirmed, the device was released by turning the cable counterclockwise using the pin vise. In all patients, chest radiography and echocardiography were performed 24 hours after the procedure. All patients were followed up for 1 to 24 months (mean 8 months). Results: Aortography showed that 11 patients had PDA type A, 1 had type B. The mean PDA diameter at its narrowest segment was 9.2 mm (ranging from 6.0 to 18.0 mm). The mean pulmonary/systemic blood flow ratio was 2.3 (ranging from 1.5 to 7.8). All patients had severe pulmonary hypertension. The device was successfully placed in the PDA in all patients. After closure, pulmonary pressure was decreased from 80-150 mmHg (1 mmHg=0.133 kPa)to 50-110 mmHg in 11, and failed to respond in one, Color Doppler revealed pulmonary pressure was decreased from 110 to 65 mmHg within 36 hours. Angiography showed that 9 patients had complete immediate closure, 2 had a trace shunt (foaming through the device with no contrast jet), and 1 had a small shunt (with a contrast jet). Color Doppler revealed complete closure in all patients within 24- 48 hours. Patients were followed up for 1-24 months (mean 8 months). Clinical examination and Color Doppler demonstrated no residual shunt. No other complications were found. Conclusion: Transcatheter closure is a for and effective interventional procedure in the treatment of PDA with severe pulmonary hypertension using ADO and ASO.