彩色多普勒超声心动图在老年动脉导管未闭封堵术中的价值

目的探讨彩色多普勒超声心动图(CDE)在老年动脉导管未闭(PDA)封堵术中的价值。方法封堵术前应用CDE筛选25例老年PDA适应证,彩色多普勒血流显像(CDFI)分流束血流信号估测PDA肺动脉端直径,与心血管造影对照,经统计学相关处理判断其正确性;连续波多普勒(CW)测量三尖瓣最大反流速度峰值,根据简化伯努利方程ΔP=4V2估算跨三尖瓣压力阶差,再加上右心房固有压力估测肺动脉压力,与心导管对照,经统计学相关处理判断其正确性;所有患者均行封堵术介入治疗,封堵术后再应用CDE判断封堵术疗效。结果根据CDE特征筛选25例老年PDA实施封堵术全部获得成功,封堵术后CDE判断疗效满意。CDFI测量分流束血流信号估测PDA肺动脉端直径与心血管造影对照,呈正相关(r=0.71,P<0.001);CW估测肺动脉压力与心导管对照,呈正相关(r=0.63,P<0.001)。结论CDE在老年PDA封堵术中具有重要价值,封堵术前筛选适应证应用CDFI估测PDA肺动脉端直径和应用CW估测肺动脉压力是关键,封堵术后判断疗效应用CDFI观察有无过PDA残余分流很重要。

The value of color Doppler echocardiography in the elderly during the procedure of patent ductus arteriosus occlusion

Objective To investigate the value of color Doppler echocardiography （CDE） in the closure of patent ductus arteriosus （PDA） in the elderly. Methods Before the occlusion, the indicantions for twenty-five elderly patients with PDA were screened by CDE. Using the shunt flow signal of color Doppler flow imaging （CDFI）, we estimated the pulmo- nary side diameter of PDA and compared with the angiocardiography and determined its accuracy through statistics. Using the continuous wave Doppler （CW）, we measured peak velocity of tricuspid regurgitation and estimated cross-tricuspid pressure gradient according to the simplified Bernoulli equation AP= 4V2 , together with the inherent right atrial pressure to estimate pulmonary artery pressure. Then, we compared cross-tricuspid pressure gradient and pulmonary artery pres- sure with cardiac catheterization and determined its accuracy through statistics. All patients underwent interventional ther- apy and were determined the efficacy of occlusion by CDE. Results All the occlusions of the elderly patients with PDA were successful through the examination by CDE. The diameter of the PDA pulmonary side estimated by the shunt flow signal had a positive correlation with angiocardiography （ r =0.71, P %0. 001）. Pulmonary artery pressure estimated by the CW had a positive correlation with cardiac catheterization contrast （ r ： 0.63, P %0. 001）. Conclusion CDE has an important value in the elderly during the procedure of patent ductus arteriosus occlusion. Using CDFI to estimate PDA pulmonary side diameter and CW to estimate pulmonary artery pressure before the occlusion is the key to screen the indica- tion of occlusion. And it is also important for using CDFI to observe whether there is a residual PDA shunt after transcath- eter closure.