艾森曼格综合征的动脉导管未闭患者能否行介入手术？

摘要

目的：探讨在艾森曼格综合征早期能否行动脉导管未闭（PDA）介入手术治疗。方法3例患者术前1周内按照注册研究规定行临床评估和肺动脉高压相关检查及登记。行右心导管检查以及肺血管扩张试验（面罩吸入万他维1支），测量试验前后肺动脉压力、降主动脉压力、肺体循环血流量比、肺体压力比、肺毛细血管嵌压[均≤15 mmHg（1 mmHg=0.133 kPa）]等，明确肺血管扩张试验结果后行试封堵试验，如为阳性，与家属沟通同意后释放封堵器；如为阴性，快速撤出封堵器并根据患者临床症状对症处理。结果病例1肺血管扩张试验阴性，试封堵试验阳性，即刻手术效果理想，经家属同意释放封堵器。病例2、病例3肺血管扩张试验阴性，试封堵试验阴性，未释放封堵器。结论部分早期艾森曼格综合征动脉导管未闭患者可行介入封堵，试封堵试验可能是一个预测预后的重要指标。%Objective To explore whether the PDA patients in the early stage of Eisenmenger syndrome can accept interventional surgery. Methods Three patients were choose from the “National Multicenter Prospective Registration Study on Pulmonary Artery Hypertension”, Clinical assessment, as well as examinations and registrations associated with PAH, was conducted in accordance with relevant provisions of the registration study within 1 wk prior to surgery. The way of the interventional treatment were right heart catheterization and pulmonary vasodilator testing (a capsule of iloprost solution for inhalation), and measurement of the pulmonary arterial pressure, descending aortic pressure, ratio of pulmonary to systemic blood flow, ratio of pulmonary to systemic blood pressure, pulmonary capillary wedge pressure [mean≤15 mmHg(1 mmHg=0.133 kPa)], before and after testing. After clear the results of pulmonary vasodilator test all patients underwent transcatheter closure testing, if it was positive,the amplatzer was released if her family members’ approved;Conversely, the amplatzer was quickly withdrawn with negative results, and symptomatic treatment was conducted based on the patient’s clinical symptoms. Results The first cases pulmonary vasodilator test was negative, but positive in transcatheter closure testing. Satisfaction immediate effect of surgery, and the occluder was released with her family members’ approval. patients of Example 2 and Example 3 were negative in pulmonary vasodilator testing and transcatheter closure testing, can not released the occluder. Conclusions Some Patents Ductus Arteriosus (PDA) patients in early stage of Eisenmenger syndrome is feasible to accept interventional therapy , try plugging test is may be an important indicator of prognostic assessment.