婴幼儿动脉导管未闭合并中-重度肺动脉高压28例的介入治疗
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摘要
目的总结动脉导管未闭(patent ductus arteriosus,PDA)合并中-重度肺动脉高压,伴重度生长发育不良婴幼儿介入治疗经验,分析其疗效。方法选择28例PDA合并有中-重度肺动脉高压的婴幼儿,均在局麻和基础麻醉下选用国产Amplatzer型封堵器行介入治疗。回顾性分析介入治疗前后及术后6个月复查的临床、心导管介入及超声心动图资料,对比分析、总结该类患儿的介入治疗经验和疗效。结果 2例患儿术后即刻见微量残余分流,术后6个月复查正常。余各例无介入治疗相关并发症发生。28例患儿介入治疗后6个月复查超声心动图检查显示,肺动脉收缩压、左房直径、左室舒张末期直径及左室运动情况均处于正常范围。结论 PDA合并中-重度肺动脉高压,且重度生长发育不良的婴幼儿选择合适的适应证行介入治疗可达到满意的即刻及中期疗效。
Objective To summarize the experience and the efficacy of interventional therapy for infant with patent ductus arteriosus(PDA) complicated with moderate to severe pulmonary arterial hypertension(PH) and severe dysplasia. Methods 28 infants with PDA and moderate to severe PH were treated with interventional therapy. The domestic Amplatzer occluder was used for interventional treatment under local and basic anesthesia. The clinical data, echocardiography and cardiac catheterization were retrospectively analyzed before and after interventional therapy, and 6 months after operation. Results Only residual shunts were observed in 2 children, which was disappeared 6 months after operation. The systolic pressure of pulmonary artery, the diameter of left atrial, the diameter of left ventricular end diastole were all recovered to normal 6 months after treatment. Conclusion Infants with PDA, moderate to severe PH and severe dysplasia can have satisfactory results with interventional therapy as suitable indication.
Objective To summarize the experience and the efficacy of interventional therapy for infant with patent ductus arteriosus(PDA) complicated with moderate to severe pulmonary arterial hypertension(PH) and severe dysplasia. Methods 28 infants with PDA and moderate to severe PH were treated with interventional therapy. The domestic Amplatzer occluder was used for interventional treatment under local and basic anesthesia. The clinical data, echocardiography and cardiac catheterization were retrospectively analyzed before and after interventional therapy, and 6 months after operation. Results Only residual shunts were observed in 2 children, which was disappeared 6 months after operation. The systolic pressure of pulmonary artery, the diameter of left atrial, the diameter of left ventricular end diastole were all recovered to normal 6 months after treatment. Conclusion Infants with PDA, moderate to severe PH and severe dysplasia can have satisfactory results with interventional therapy as suitable indication.
引文
[1] 张端珍,朱鲜阳,崔春生,等. 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.
[2] Zhang DZ, Zhu XY, Lv B, et al. Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure[J]. Circ Cardiovasc Interv,2014,7(4):473-481.
[3] Turck D,Michaelsen KF, Shamir R, et al.World Health Organization 2006 child growth standards and 2007 growth reference charts: A discussion paper by the committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition[J]. J Pediatr Gastroenterol Nutr, 2013, 57(2):258-264.
[4] Gamboa R, Mollon FP, Rios-Mendez RE, et al.Patent ductus arteriosus closure using a new device: the Nit-Occlud device[J]. Rev Esp Cardiol, 2007, 60(4):445-448.
[5] Huggon IC, Qureshi SA. Is the prevention of infective endarteritis a valid reason for closure of the patent arterial duct?[J]. Eur Heart J, 1997, 18(3):364-366.
[6] 王琦光,朱鲜阳,张瑞珍,等. 巨大动脉导管未闭的介入治疗策略[J]. 中国介入心脏病学杂志, 2016,24(5):251-255.
[7] 王琦光, 朱鲜阳,张瑞珍,等. 体质量≤8kg小儿动脉导管未闭封堵治疗[J]. 介入放射学杂志, 2014,23(2):100-103.
[8] Wang JK, Hwang JJ, Chiang FT, et al. A strategic approach to transcatheter closure of patent ductus: Gianturco coils for small-to-moderate ductus and Amplatzer duct occluder for large ductus[J]. Int J Cardiol, 2006, 106(1):10-15.
[9] 吴琳,盛锋,刘芳,等. 儿童动脉导管未闭介入堵闭术的临床疗效评价[J]. 复旦学报:医学版, 2007,34(5):760-763.
[10] 曹黎明,王凤鸣,秦玉春,等. 封堵试验对儿童动脉导管未闭并发重症肺动脉高压性质的判定及介入治疗的意义[J]. 中国实用儿科杂志, 2017,32(2):145-148.
[11] Faella HJ, Hijazi ZM. Closure of the patent ductus arteriosus with the amplatzer PDA device: immediate results of the international clinical trial[J]. Catheter Cardiovasc Interv, 2000, 51(1):50-54.
[12] Karapinar H, Kucukdurmaz Z,Oflaz MB, et al. Closure of patent ductus arteriosus with oversized Amplatzer occluder in a patient with pulmonary hypertension[J]. Postepy Kardiol Interwencyjnej, 2013, 9(1): 93-96.
[13] 岳峰,刘晓桥,张萍,等. 动脉导管未闭介入封堵术后血小板减少的临床分析及防治[J]. 实用医学杂志, 2014,30(21):3471-3473.
[14] Ewert P. Challenges encountered during closure of patent ductus arteriosus[J]. Pediatr Cardiol, 2005, 26(3):224-229.
[15] 谢渡江,周陵,李小波,等. 国产蘑菇伞介入治疗动脉导管未闭合并中度以上肺动脉高压的临床随访[J]. 广东医学, 2013,34(14):2211-2213.
[16] 张端珍,朱鲜阳,崔春生,等. 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.
[2] Zhang DZ, Zhu XY, Lv B, et al. Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure[J]. Circ Cardiovasc Interv,2014,7(4):473-481.
[3] Turck D,Michaelsen KF, Shamir R, et al.World Health Organization 2006 child growth standards and 2007 growth reference charts: A discussion paper by the committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition[J]. J Pediatr Gastroenterol Nutr, 2013, 57(2):258-264.
[4] Gamboa R, Mollon FP, Rios-Mendez RE, et al.Patent ductus arteriosus closure using a new device: the Nit-Occlud device[J]. Rev Esp Cardiol, 2007, 60(4):445-448.
[5] Huggon IC, Qureshi SA. Is the prevention of infective endarteritis a valid reason for closure of the patent arterial duct?[J]. Eur Heart J, 1997, 18(3):364-366.
[6] 王琦光,朱鲜阳,张瑞珍,等. 巨大动脉导管未闭的介入治疗策略[J]. 中国介入心脏病学杂志, 2016,24(5):251-255.
[7] 王琦光, 朱鲜阳,张瑞珍,等. 体质量≤8kg小儿动脉导管未闭封堵治疗[J]. 介入放射学杂志, 2014,23(2):100-103.
[8] Wang JK, Hwang JJ, Chiang FT, et al. A strategic approach to transcatheter closure of patent ductus: Gianturco coils for small-to-moderate ductus and Amplatzer duct occluder for large ductus[J]. Int J Cardiol, 2006, 106(1):10-15.
[9] 吴琳,盛锋,刘芳,等. 儿童动脉导管未闭介入堵闭术的临床疗效评价[J]. 复旦学报:医学版, 2007,34(5):760-763.
[10] 曹黎明,王凤鸣,秦玉春,等. 封堵试验对儿童动脉导管未闭并发重症肺动脉高压性质的判定及介入治疗的意义[J]. 中国实用儿科杂志, 2017,32(2):145-148.
[11] Faella HJ, Hijazi ZM. Closure of the patent ductus arteriosus with the amplatzer PDA device: immediate results of the international clinical trial[J]. Catheter Cardiovasc Interv, 2000, 51(1):50-54.
[12] Karapinar H, Kucukdurmaz Z,Oflaz MB, et al. Closure of patent ductus arteriosus with oversized Amplatzer occluder in a patient with pulmonary hypertension[J]. Postepy Kardiol Interwencyjnej, 2013, 9(1): 93-96.
[13] 岳峰,刘晓桥,张萍,等. 动脉导管未闭介入封堵术后血小板减少的临床分析及防治[J]. 实用医学杂志, 2014,30(21):3471-3473.
[14] Ewert P. Challenges encountered during closure of patent ductus arteriosus[J]. Pediatr Cardiol, 2005, 26(3):224-229.
[15] 谢渡江,周陵,李小波,等. 国产蘑菇伞介入治疗动脉导管未闭合并中度以上肺动脉高压的临床随访[J]. 广东医学, 2013,34(14):2211-2213.
[16] 张端珍,朱鲜阳,崔春生,等. 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.