张端珍, 朱鲜阳, 崔春生, 侯传举, 王琦光. 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[J]. 心脏杂志, 2014, 26(6): 708-712.
    引用本文: 张端珍, 朱鲜阳, 崔春生, 侯传举, 王琦光. 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[J]. 心脏杂志, 2014, 26(6): 708-712.
    shu
    Changes of pulmonary artery pressure after transcatheter closure of patent ductus arteriosus complicated with severe pulmonary arterial hypertension[J]. Chinese Heart Journal, 2014, 26(6): 708-712.
    Citation: Changes of pulmonary artery pressure after transcatheter closure of patent ductus arteriosus complicated with severe pulmonary arterial hypertension[J]. Chinese Heart Journal, 2014, 26(6): 708-712.
    shu

    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

    Changes of pulmonary artery pressure after transcatheter closure of patent ductus arteriosus complicated with severe pulmonary arterial hypertension

      摘要
    • 摘要: 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，mPAP)>55 mmHg，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（P<0.05），但mPAP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mPAP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/Qs>1.5，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。

       

      Abstract: AIM:To evaluate the changes of pulmonary artery pressure (PAP) in patients with patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension (PAH) after transcatheter device closure. METHODS: Transcather closure of PDA was performed in 111 patients with mean PAP (mPAP) >55 mmHg and pulmonary-to-systemic flow ratio (Qp/Qs) >1.5. PAP and aortic pressure were measured before and after device closure. Patients were followed clinically and with echocardiogram. RESULTS: All patients underwent successful transcatheter closure of PDA without major complications. PAP fell significantly (P<0.05) after device closure of PDA, but mPAP restored to normal level in only 37 patients (33.3%) immediately after PDA closure, and mild, moderate and severe PAH was, respectively, observed in 51, 14 and nine patients. The follow-up period was 1-8 (median 4) years. Twenty-four patients had PAH at 3 months after procedure but only 15 (13.5%) of them had PAH at 6 months, which was persistent during the whole follow up. Device closure resulted in drop in mPAP by (59±10)% in patients without PAH but only (24±14)% in patients with persistent post-procedural PAH (P<0.05). None of the patients with normal PAP and mild PAH but patients with severe PAH after PDA closure before device release had persistent post-procedural PAH. CONCLUSION: In patients with PDA and severe PAH, 13.5% will have persistent post-procedural PAH, although the pre-procedural Qp/Qs ratio is>1.5. Persistent post-procedural PAH will be inevitable in patients with severe PAH immediately after PDA closure and PAH will be persistent if the PAP is still higher than normal 6 months after procedure.

       

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