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目的总结伴重度肺动脉高压,而左心室内径正常的动脉导管未闭(PDA)患者的临床特点和经导管介入封堵治疗疗效。方法采用经胸心脏超声和主动脉降部造影诊断6例表现为右房右室显著扩大,而左心室内径正常的重度肺动脉高压PDA患者,明确诊断后行经皮介入封堵治疗,术后行经胸心脏超声随访。结果4例患者经胸心脏超声,2例经主动脉降部造影检查明确诊断。所有患者经胸超声表现为右房、右室和肺动脉内径显著增宽,重度肺动脉高压,左心室内径正常。4例经皮介入封堵成功,其中3例试封堵后肺动脉压明显下降,1例试封堵后肺动脉压下降不明显,随访中肺动脉压持续下降,但仍未恢复正常。随访中无严重并发症发生,患者临床症状明显改善,心功能改善。结论对于表现为右心显著扩大,左室内径正常的重度肺动脉高压PDA患者经胸超声胸骨旁高位动脉导管切面有助于提高诊断率。介入封堵治疗对部分患者切实、可行,近期效果好。
Objective To summarize the clinical features of patients with patent ductus arteriosus (PDA) who have severe pulmonary hypertension and normal left ventricular diameter, and the efficacy of transcatheter closure. Methods Transient thoracic echocardiography and descending aorta angiography were used to diagnose 6 cases of severe right-sided right ventricle with enlarged right ventricle. Patients with severe pulmonary hypertension with normal left ventricle diameter were diagnosed with percutaneous intervention and post-operative thoracotomy Echocardiographic follow-up. Results Four patients underwent transthoracic echocardiography and two patients underwent definite diagnosis by aortic descending imaging. All patients showed transthoracic ultrasound right atrium, right ventricle and pulmonary artery diameter significantly wider, severe pulmonary hypertension, left ventricular diameter was normal. 4 cases of successful percutaneous closure, including 3 cases of test after the closure of pulmonary artery pressure decreased significantly, 1 case of test after blocking the pulmonary arterial pressure drop was not significant, follow-up pulmonary arterial pressure continued to decline, but still not returned to normal. No serious complications occurred during the follow-up. The clinical symptoms of the patients were significantly improved and the cardiac function improved. Conclusions The transthoracic transposition of the sternum superior thyroid artery catheter in patients with severe pulmonary hypertension whose left ventricle diameter is significantly enlarged and whose left ventricular diameter is normal can help to improve the diagnosis rate. Interventional closure therapy for some patients practical and feasible, the recent effect is good.