介入治疗合并肺动脉高压的中老年继发孔型房间隔缺损的安全性和有效性Percutaneous device closure of atrial septal defect in patients over 40 years of age with pulmonary arterial hypertension
王诚,赵世华,蒋世良,黄连军,徐仲英,凌坚,郑宏,张戈军,闫朝武,戴汝平
摘要(Abstract)：
目的探讨经导管治疗合并肺动脉高压的中老年继发孔型房间隔缺损(ASD)的安全性和有效性。方法1997年10月至2006年2月,48例合并肺动脉高压(右心导管测量肺动脉平均压>25mmHg)的ASD患者接受了封堵治疗(同期196例无肺动脉高压为对照组)。分析经导管封堵后肺动脉收缩压、心功能以及右心室、肺动脉直径变化。结果48例中47例封堵治疗成功,技术成功率97.9%,即刻残余分流率为2.1%(1/48)。全组缺损经胸超声心动图(TTE)最大径18.9±5.1mm。封堵后即刻肺动脉收缩压由61.2±12.6mmHg降至43.0±8.4mmHg(P<0.01),肺动脉平均压由31.1±4.8mmHg降至26.0±3.4mmHg(P<0.05),全肺阻力由2.9±1.4mmHg.min(Wood单位)降至1.9±0.8mmHg.min(P<0.01)。封堵后第1天,主肺动脉直径由术前的30.2±7.3mm降至27.2±5.8mm(P<0.01),右心室前后径由35.4±7.6mm降至28.0±7.0mm(P<0.01)。全组并发症发生率8.3%(4/48),其中操作相关并发症4.2%。随访8.7±15.4个月(1～60个月),随访期间肺动脉收缩压进一步下降,肺动脉直径、右心室前后径进一步减小,心电图右束支传导阻滞比例降低,NYHA心功能分级改善。结论经导管封堵治疗合并轻中度肺动脉高压的中老年ASD安全、有效,术后肺动脉压降低,心功能改善,近、中期疗效显著。
关键词(KeyWords)： 房间隔缺损;心脏导管插入术;肺动脉高压;中老年
基金项目(Foundation):
作者(Author): 王诚,赵世华,蒋世良,黄连军,徐仲英,凌坚,郑宏,张戈军,闫朝武,戴汝平
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