成人经皮动脉导管未闭封堵术后主动脉瓣关闭不全的临床分析

目的 分析成人经皮动脉导管未闭(patent ductus arteriosus,PDA)封堵术后发生主动脉瓣关闭不全(aortic regurgitation,AR)的风险、临床相关因素及转归.方法 入选101例PDA成年患者,分析PDA封堵术后26例(25.74％)新发生AR或AR程度加重患者的基本临床特征、PDA特征、封堵情况及转归,利用logistic回归模型分析发生AR的危险因素.结果 26例新发生AR或AR程度加重患者与未发生AR患者比较,平均肺动脉压[(46.2±20.7)vs (31.4±17.5)mmHg,1 mmHg=0.133 kPa]、左心室舒张末期内径[(5.2±0.2)vs (4.2±0.4)cm]、PDA大小[(14.0±6.4) vs (9.0±3.5) cm]、术前有轻度AR患者发生率38.46％(10/26) vs 18.67％(14/75)]差异均有统计学意义(P＜0.05).Logistic回归分析提示左心室舒张末期内径(OR=33.541,95％ CI:5.883～191.235,P=0.000)和PDA大小(OR=7.512,95％ CI:1.976～28.564,P=0.003)是AR的独立危险因素.随访期间,26例AR患者中有22例(84.62％) AR愈合,1例于术后第30个月死于进行性加重的AR及心力衰竭.结论 左心室舒张末期内径和PDA大小是成人经皮PDA封堵术后发生AR的独立危险因素.大多数AR患者的转归良好.

Aortic valve regurgitation following transcatheter closure of patent ductus arteriosus in adults: a clinical analysis

Objective To determine the incidence, risks and outcome of aortic regurgitation (AR) following transcatheter closure in adult patients with patent ductus arteriosus (PDA). Methods A total of 101 patients with PDA treated by transcatheter closure were enrolled in this study. Of them, 26 patients (25.74%) had new or increased AR following closure. The relevant factors including clinical manifestations, PDA features, closure procedure and outcome were analyzed and the risk factors were screened with logistic regression analysis. Results The 26 patients with newly diagnosed AR patients or with aggravated AR had significantly higher pulmonary arterial pressure than those without AR ([46.2±20.7] mmHg vs [31.4±17.5] mmHg, 1 mmHg=0.133 kPa), significantly larger left ventricular end diastolic dimension (LVEDD, [5.2±0.2] cm vs [4.2±0.4] cm), significantly more severe PDA ([14.0±6.4] cm vs [9.0±3.5] cm) and significantly higher incidence of preoperative mild AR (38.46% [10/26] vs 18.67% [14/75]) (all P<0.05). Logistic regression analysis demonstrated that LVEDD (OR=33.541, 95% CI: 5.883-191.235, P=0.000) and PDA diameter (OR=7.512, 95% CI: 1.976-28.564, P=0.003) were the independent predictive factors for AR. During follow-up, 22 (84.62%) AR patients regained aortic valvar competence, and one died of AR deterioration and heart failure at the 30^th months. Conclusion It is more possible for the patients with larger LVEDD and severer PDA to develop AR. Most AR patients have a better outcome.