室间隔缺损介入封堵肺动脉压力变化规律的研究

目的：探讨成功介入封堵治疗的室间隔缺损（VSD ）在封堵前后即刻、随访期肺动脉压力的变化规律。方法650例成功施行介入治疗的VSD患者，经导管测定术前及封堵后即刻肺动脉压力，并于介入术前当日、术后3d、1、3、6个月分别应用超声心动图测定肺动脉压力并进行对比。结果肺动脉收缩压（PASP）和肺动脉平均压（PAMP）超声和心导管测值均显著正相关：（1）正常肺动脉压力组：PASP和PAM P在封堵即刻后及随访期差异均无统计学意义。（2）轻度肺高压组：PASP在封堵即刻后无明显变化，6个月时与封堵前后比较均显著下降（P＜0．05）。PAMP在封堵即刻后升高，术后1个月及6个月与封堵后比较均显著降低（P＜0．05）。（3）中度肺高压组：PASP及PAMP在封堵即刻后均显著降低（P＜0．05），两者在术后3 d 及随访中与封堵前比较进行性降低（P＜0．05）；PASP在术后1、3、6个月较封堵后降低（P＜0．05）。结论经导管封堵治疗能明显降低VSD合并轻、中度肺动脉高压患者肺动脉压力，近、中期疗效确切。

Study on the changes of pulmonary artery pressure in ventricular septal defect patients after tran-scatheter occlusion treatment

Objective To compare the changes of pulmonary artery pressure （systolic pulmonary pressure ,PASP ;mean pulmonary pressure ,PAMP） before and after transcatheter occlution in pa-tients with ventricular septal defect （VSD） .Methods Total of 650 patients with VSD underwent tran-scatheter closure were involved in this study .The parameters of pulmonary artery pressure including PASP and PAMP were evaluated with cardiac catheter before and after procedures .Transthoracic ech-ocardiography examination performed at 3 days after procedures and during follow-up of next 1 ,3 and 6 months .Results There were significantly relationship between the pulmonary arterial pressure from Doppler echocardiography examination and cardiac catheter examination before transcatheter occlusion in patients with VSD （PASP ：r=0 .810 ,P＆lt;0 .05 ;PAMP ：r=0 .819 ,P＆lt;0 .05 .Pearson） .In normal group ,PASP had not significant changes .PAMP increased at 3 months from the operation .In mild pulmonary hypertension group ,PASP and PAMP increased immediately after operation ,which de-creased apparently at 6 months .In moderate pulmonary hypertension group ,PASP and PAMP de-creased apparently immediately after the operation .The pulmonary pressure had been decreasing dur-ing the following 6 months .Conclusion Transcatheter closure of VSD with mild or moderate pulmona-ry hypertension is safe and effective .