高海拔地区动脉导管未闭并发重度肺高压患者的经导管封堵疗效评价
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摘要
目的评估在综合评估指导下,高海拔地区患动脉导管未闭并发重度肺动脉高压的患者,经导管封堵治疗的即刻、短期疗效。方法 2017年9月至2018年6月在云南省阜外心血管病医院应用指脉氧饱和度、心脏听诊、胸片、超声心动图综合评估手段对18例患者进行评估,分别在不同时机进行吸氧试验和封堵试验,封堵术后1个月、3个月复查超声心动图。结果 16例封堵有效,释放封堵伞,1例封堵后肺动脉压上升收回封堵伞,1例患者因动脉导管过大不能有效封堵而放弃封堵。经评估后可直接封堵组吸氧前后肺-体循环血流量的比值(Qp/Qs)均大于试封堵组;封堵后肺动脉平均压低于试封堵组,差异有统计学意义(P<0.05)。所有患者在术中和术后均未发生肺高压危象和严重并发症;患者心功能改善,心脏不同程度缩小。结论针对高海拔地区动脉导管未闭并发重度肺动脉高压的患者,进行综合评估和药物、吸氧治疗,选择时机进行经导管封堵治疗是一种安全、有效的方法。
Objectives To assess the immediate and short-term outcomes of transcatheter closure in patients with patent ductus arteriosus(PDA)and severe pulmonary hypertension(PH)at high altitudes under the guidance of a comprehensive assessment. Methods Eighteen patients were assessed by digital oxygen saturation,cardiac auscultation,chest X-ray and color Doppler echocardiography from September 2017 to June 2018 in Fuwai Hospital of Yunnan. Oxygen inhalation test and occlusion test were performed at different times. Echocardiogram was reexamined 1 month and 3 months after occlusion. Results The occlusion was effective in 16 cases. The pulmonary artery pressure rose in 1 case and the occlusion umbrella was retracted. The occlusion was abandoned in 1 case. Ratio of pulmonary blood flow to systemic blood flow(Qp/Qs)of direct occlusion group before and after oxygen inhalation were higher than those of test occlusion group(P<0.05),and mean pulmonary artery pressure after occlusion in direct occlusion group was lower than that of test occlusion group(P<0.05). No pulmonary hypertension crisis or serious complications occurred in all patients during and after the operation,and the cardiac function was improved and the heart size was reduced in varying degrees. Conclusions It is a safe and effective method to evaluation and select the right time for patients with PDA and severe PH treated by transcatheter closure in high altitude.
Objectives To assess the immediate and short-term outcomes of transcatheter closure in patients with patent ductus arteriosus(PDA)and severe pulmonary hypertension(PH)at high altitudes under the guidance of a comprehensive assessment. Methods Eighteen patients were assessed by digital oxygen saturation,cardiac auscultation,chest X-ray and color Doppler echocardiography from September 2017 to June 2018 in Fuwai Hospital of Yunnan. Oxygen inhalation test and occlusion test were performed at different times. Echocardiogram was reexamined 1 month and 3 months after occlusion. Results The occlusion was effective in 16 cases. The pulmonary artery pressure rose in 1 case and the occlusion umbrella was retracted. The occlusion was abandoned in 1 case. Ratio of pulmonary blood flow to systemic blood flow(Qp/Qs)of direct occlusion group before and after oxygen inhalation were higher than those of test occlusion group(P<0.05),and mean pulmonary artery pressure after occlusion in direct occlusion group was lower than that of test occlusion group(P<0.05). No pulmonary hypertension crisis or serious complications occurred in all patients during and after the operation,and the cardiac function was improved and the heart size was reduced in varying degrees. Conclusions It is a safe and effective method to evaluation and select the right time for patients with PDA and severe PH treated by transcatheter closure in high altitude.
引文
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[2]LOWE B S,THERRIEN J,IONESCU-ITTU R,et al.Diagnosis of pulmonary hypertension in the congenital heart disease adult population impact on outcomes[J].J Am Coll Cardiol,2011,58(5):538-546.
[3]LAI Y C,POTOKA K C,CHAMPION H C,et al.Pulmonary arterial hypertension:the clinical syndrome[J].Circ Res,2014,115(1):115-130.
[4]先天性心脏病相关性肺动脉高压诊治中国专家共识[J].中国介入心脏病学杂志,2015,23(2):61-69.
[5]BEGHETTI M,GALIèN,BONNET D.Can“inoperable”congenital heart defects become operable in patients with pulmonary arterial hypertension dream or reality[J].Congenit Heart Dis,2012,7(1):3-11.
[6]YAN C,ZHAO S,JIANG S,et al.Catheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults[J].Heart,2007,9:514-518.
[7]RABINOVITCH M,GUIGNABERT C,HUMBERT M,et al.Inflammation and immunity in the pathogenesis of pulmonary arterial hypertension[J].Circ Res,2014,115(1):165-175.
[8]BEGHETTI M,TISSOT C.Pulmonary hypertension in congenital shunts[J].Rev Esp Cardiol,2010,63(10):1179-1193.
[9]LEHNER A,ULRICH S,HAPPEL C M,et al.Closure of very large PDA with pulmonary hypertension:Initial clinical caseseries with the new Occlutech(R)PDA occluder[J].Catheter Cardiovasc Interv,2017,89(4):718-725.