联合标准在房间隔缺损合并显著肺动脉高压诊治中的有效性

郑然; 吴容展

doi:10.13201/j.issn.1001-1439.2019.07.021

联合标准在房间隔缺损合并显著肺动脉高压诊治中的有效性

郑然^,,
吴容展

- 梧州市红十字会医院心内科1区(广西梧州,543002)

详细信息

通讯作者: 郑然, E-mail:13977489017@139.com

中图分类号: R541.1;R544.1

收稿日期: 2019-02-20

Validity of combined criteria in diagnosis and treatment of atrial septal defect with significant pulmonary hypertension

ZHENG Ran^,,
WU Rong-zhan

- Department of Cardiology, Red Cross Hospital, Wuzhou, Guangxi, 543002, China

More Information

Corresponding author: ZHENG Ran, E-mail: 13977489017@139.com

Received Date: 20 February 2019

摘要

摘要: 目的:对房间隔缺损 (atrial septal defect, ASD) 合并显著肺动脉高压 (pulmonary arterial hypertension, PAH) 患者介入封堵术后进行中长期随访, 评估临时封堵试验和选择性肺动脉造影对分流闭合前确定PAH是否可逆的长期预测的有效性及安全性。方法:纳入2008-2018年8例ASD合并显著PAH患者。采用联合评估方法确定患者是否能手术治疗。其中3例患者因介入术后肺动脉压力仍较高而接受PAH特异性药物治疗。整理分析患者介入封堵前、术后1d、术后1个月及≥6个月随访终点时的超声心动图资料。结果:所有患者均直接进行介入封堵治疗。随访6~48 (27.63±15.22) 个月期间, 超声估测的肺动脉收缩压 (estimated systolic pulmonary artery pressure, sPAP) 与术前相比显著降低[ (52.00±17.73) mmHg∶ (27.63±7.42) mmHg, 1mmHg=0.133kPa, P=0.002]。其中2例患者术后肺动脉压力过高, 在PAH特异性药物终止后仍能逐渐下降至接近正常。结论:对符合联合评估的与ASD相关的显著PAH患者采取先手术后PAH特异性药物的治疗策略是安全和有效的。
- 先天性心脏病 /
- 房间隔缺损 /
- 心脏导管插入术 /
- 肺动脉高压
Abstract: Objective:To evaluate the effectiveness and safety of temporary occlusion test and selective pulmonary angiography in long-term prediction of reversibility of atrial septal defect (ASD) with pulmonary hypertension (PAH) before shunt closure.Method:Eight ASD patients with significant PAH from 2008 to 2018 were enrolled.The joint assessment was used to determine whether patients could be treated surgically.Among 8 patients, 3 cases received PAH-specific drug therapy because of the high pulmonary pressure after interventional therapy.The echocardiographic data of patients before interventional occlusion, 1 day after operation, 1 month after operation, and the end point of follow-up of more than 6 months were analyzed.Result:All patients were treated with interventional occlusion directly.During a follow-up with 6 to 48 (27.63±15.22) months, the estimated systolic pulmonary artery pressure (sPAP) estimated by ultrasound was significantly lower than that before surgery[ (52.00±17.73) mmHg vs. (27.63± 7.42) mmHg, 1 mmHg=0.133 kPa, P=0.002].In 2 cases, the pulmonary artery pressure was too high after operation, and it gradually decreased to near normal after the termination of PAH-specific drugs.Conclusion:It is safe and effective to receive PAH-specific drug therapy after operation for patients with significant ASD-related PAH who accept the joint assessment.
- congenital heart disease /
- atrial septal defect /
- heart catheterization /
- pulmonary hypertension

HTML全文

参考文献(15)

[1]	Sanchez-Recalde A, Oliver JM, Galeote G, et al.Atrial septal defect with severe pulmonary hypertension in elderly patients:usefulness of transient balloon occlusion[J].Rev Esp Cardiol, 2010, 63 (7):860-864.
[2]	Fujiyama J, Yoshida Y, Ogata H, et al.Pulmonary wedge angiography for the evaluation of the pulmonary vascular bed in congenital heart disease[J].Cathet Cardiovasc Diagn, 1984, 10 (3):237-246.
[3]	Wilson NJ, Culham JA, Sandor GG, et al.Pulmonary wedge angiography for prediction of pulmonary vascular disease in Down syndrome[J].Cathet Cardiovasc Diagn, 1993, 28 (1):22-33.
[4]	肖书娜, 尚小珂, 张刚成, 等.肺小动脉楔入造影对先天性心脏病患儿肺动脉高压的评估价值[J].中国介入心脏病学杂志, 2016, 1 (24):18-22.
[5]	Subias PE, SEC Working Group for ESC/ERS 2015Guidelines for Diagnosis and Treatment of Pulmonary Hypertension, Expert Reviewers for ESC/ERS 2015Guidelines for Diagnosis and Treatment of Pulmonary Hypertension, et al.Comments on the 2015ESC/ERSGuidelines for the Diagnosis and Treatment of Pulmonary Hypertension[J].Rev Esp Cardiol (Engl Ed), 2016, 69 (2):102-108.
[6]	Rudski LG, Lai WW, Afilalo J, et al.Guidelines for the echocardiographic assessment of the right heart in adults:a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography[J].J Am Soc Echocardiogr, 2010, 23 (7):685-713.
[7]	Dimopoulos K, Rgoletto I.Improved survival among patients with Eisenmenger syndrome receiving advanced therapy for pulmonary arterial hypertension[J].Circulation, 2010, 121 (1):20-25.
[8]	Kijima Y, Akagi T, Takaya Y, et al.Treat and repair strategy in patients with atrial septal defect and significant pulmonary arterial hypertension[J].Circ J, 2016, 80 (1):227-234.
[9]	Supomo S, Hartopo AB, Anggrahini DW, et al.Large atrial septal defect closure in a patient with severe pulmonary arterial hypertension[J].Korean J Thorac Cardiovasc Surg, 2017, 50 (5):378-381.
[10]	Yu T, Emoto N, Miyagawa K, et al.Subsequent shunt closure after targeted medical therapy can be an effective strategy for secundum atrial septal defect with severe pulmonary arterial hypertension:two case reports:Strategy for ASD with Severe PAH[J].Heart Vessels, 2014, 29 (2):282-285.
[11]	Kim YH, Yu JJ, Yun TJ, et al.Repair of atrial septal defect with Eisenmenger syndrome after long-term sildenafil therapy[J].Ann Thorac Surg, 2010, 89 (5):1629-1630.
[12]	于亦华.西地那非在高原地区先天性心脏病合并肺动脉高压中的应用[J].临床心血管病杂志, 2010, 10 (26):787-788.
[13]	McGoon MD.The assessment of pulmonary hypertension[J].Clin Chest Med, 2001, 22 (3):493-508.
[14]	潘微, 李渝芬, 李国业, 等.选择性肺动脉造影对先天性心脏病合并肺动脉高压的肺血管评价[J].中华儿科杂志, 2002, 40 (2):111-112.
[15]	潘世伟, 萧明第, 刘迎龙, 等.选择性肺动脉造影评价先天性心脏病肺动脉高压的初步分析[J].中华心血管病杂志, 1997, 25 (1):39-42.