经导管封堵治疗成人动脉导管未闭合并重度肺动脉高压病人的护理

总结9例成人动脉导管未闭合并重度肺动脉高压病人行经导管封堵治疗的护理,强调术前加强心理护理、基础护理、术前准备,术中密切配合,术后做好穿刺肢体和伤口的护理、预防血栓形成、溶血的观察与护理等。     

合并肺动脉高压动脉导管未闭试封堵治疗临床分析

动脉导管未闭(PDA)介入封堵治疗已常规开展。近期，我们对2例合并肺动脉高压的PDA患者进行试封堵治疗，结果未成功，现将经验教训报告如下。     

特大直径动脉导管未闭合并重度肺动脉高压的介入治疗1例

我们成功地用Ａｍｐｌａｔｚｅｒ房间隔堵闭器堵闭 1例特大直径动脉导管未闭合并重度肺动脉高压和心功能不全的病人 ,随访 2 6个月 ,无残余分流、器堵闭移位及其他并发症。1　临床资料病人 ,男性 ,4 2岁。自幼发现心脏杂音 ,活动后心悸、气短 4 0ａ ,先后多家医院诊断为“先天性心脏病、动脉导管未闭”。近 1ａ来 ,病人症状明显加重 ,活动受限 ,于 2 0 0 0年 4月 12日入我院心内科。查体 :心界向两侧扩大。听诊 :胸骨左缘粗糙收缩期杂音伴震颤。Ｘ线胸片 :两肺血明显增多 ,肺动脉段明显突出 ,双心室扩大 ,以左心室扩大为著。超声心动图 :动…     

动脉导管未闭合并重度肺动脉高压的外科治疗

目的探讨动脉导管未闭(PDA)合并重度肺动脉高压(肺动脉收缩压>90mmHg)的手术治疗方法。方法回顾性分析26例动脉导管未闭合并重度肺动脉高压的手术治疗方法;4例采用单纯结扎,20例采用体外循环直视下肺动脉切开PDA缝合术,2例采用左心转流下降主动脉切开PDA缝合术。结果单纯结扎4例中有2例导管再通。体外循环直视下肺动脉切开PDA缝合术20例中有1例肺动脉壁切口缝合出血,再次体外循环,出现低心排血量综合征死亡。2例采用左心转流下降主动脉切开PDA缝合术痊愈。结论PDA合并重度肺动脉高压如果伴有其他心内畸形,可采用体外循环下切开肺动脉干PDA缝合术。如果单纯PDA合并重度肺动脉高压,应直接采用左心转流下降主动脉切开PDA缝合术。     

肺动脉高压型动脉导管未闭的超声诊断

目的初步总结超声对36例合并肺动脉高压(PH)的先天性动脉导管未闭(PDA)的诊断经验。方法对疑诊合并PH的PDA患者进行超声心动图检测,应用二维、彩色及频谱多普勒超声重点观察肺动脉长轴分叉部及主动脉弓降部检测导管情况。结果超声对合并PH的PDA的诊断准确率为94.4%,2例漏诊。超声对PH的诊断率为97%,通过三尖瓣反流或(和)导管分流压差法估测重度PH15例,中度PH10例,轻度10例,1例轻度PH漏诊。结论先天性PDA合并重度PH可能发生漏诊,但多普勒超声心动图能提高本病的诊断率,并有助于评价PH程度,是目前最常用的、最有意义的影像学诊断方法。     

成人巨大先天性动脉导管未闭伴重度肺动脉高压经导管封堵治疗1例

患者，女，43岁。胸闷、心悸8年余，加重10余天。体检：体温35．2℃，脉搏88次／min，血压105／85mmHg。无紫绀，听诊心率120次／min，心律不齐，胸骨左缘第2肋间可闻及收缩期杂音，心尖部闻及3／6级收缩期吹风样杂音，P2亢进，肝脾不肿大，双下肢水肿。心电图为快速性心房纤颤，右室高电压，左室高电压。胸片示肺纹理增多，肺门增大，肺动脉段突出3cm，右下肺动脉直径2．5cm，右室扩大。股动脉血氧饱和度93．9％，经胸超声心动图全心扩大，肺动脉增宽，降主动脉与主肺动脉起始部之间可见异常交通，宽约15mm，长约10mm，呈窗型，多普勒检查示分流以左向右为主，跨导管压差7mmHg，偶见微量右向左分流，压差0．6mmHg，     

动脉导管未闭的介入治疗及随访分析

目的总结动脉导管未闭（PDA）介入封堵治疗的临床疗效和随访结果。方法 PDA患者35例,男14例,女21例,年龄3～55岁,体重10～62 kg,肺动脉高压26例,肺动脉平均压33～61 mm Hg（1 mm Hg=0.133 kPa）,19例患者左心室扩大。降主动脉侧位造影显示病理解剖类型为漏斗型29例,管型6例,最窄处直径2～10 mm,均经股静脉途径行封堵术,超声心动图随访。结果所有患者均成功封堵,术后即刻完全封堵33例,2例有少量残余分流,术后24 h彩色多普勒超声检查示分流消失,随访6～96个月,肺动脉压均有下降,左心室内径较前缩小,无严重并发症。结论 PDA介入封堵治疗是安全有效的方法。     

右心超声造影在动脉导管未闭合并重度肺动脉高压诊断中的应用价值

动脉导管未闭（PDA）是一种常见的器质性先天性心脏病。目前，主要依据超声心动图确诊。虽然超声心动图能明确大部分的PDA，然而当PDA合并重度肺动脉高压时，掩盖了PDA的特殊心音及超声表现；超声心动图极易误诊为原发性肺动脉高压。本文拟对这类患者的超声诊断加以总结分析。     

成人动脉导管未闭的UCG特点及肺动脉收缩压估测

目的:总结成人动脉导管未闭(PDA)的UCG特点,减少误诊和漏诊,提高肺动脉高压(PH)的检出效率。方法:选取55例成人PDA患者,分成4组:中重度PH组共27例,其中左心室内径正常组12例,左心室内径增大组15例;轻度PH组14例;无PH组14例。选取同期体检的健康成人55名为对照组。结果:各PH与无PH组比较,分流束宽、收缩期Vmax及PGs、舒张期Vmin及PGd、Vmax/Vmin差异均有统计学意义。中重度PH 95%的Vmax小于3.80 m/s,95%的Vmin小于1.75 m/s,95%的Vmax/Vmin大于2.05,95%以上的分流束大于10.74 mm。结论:成人PDA患者常合并PH,除瓣膜反流估测肺动脉收缩压(PASP)外,分流频谱的Vmax、Vmin及Vmax/Vmin可用于无创性估测PASP。     

成人动脉导管未闭介入治疗的疗效评价

目的评价成人动脉导管未闭(PDA)的介入治疗方法、疗效及其特殊性.方法全组18例,男4例,女14例,平均年龄33岁,最窄直径(5.0±2.27)mm,采用Amplatzer PDA封堵伞治疗.术后24h及3～51个月X线照片及彩色多普勒随访.结果技术成功率100%,即时造影显示6例无残余分流,12例有少量残余分流,24h复查17例无残余分流,1例少量分流,3～51个月随访情况同前.结论成人PDA的介入治疗是一种有效的非手术方法.     

Transcatheter closure of the patent ductus arteriosus

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Although surgery is still required in symptomatic neonates, the majority of older infants and children can undergo safe and effective transcatheter device closure on an out-patient basis. First described in 1967, over the past four decades, numerous devices have been specifically developed for this purpose. This article will review the current status of transcatheter therapy. The experience with each device is detailed and issues and controversies are reviewed.     

Transcatheter closure of patent ductus arteriosus

More than three decades have passed since the introduction of transcatheter devices for closure of patent ductus arteriosus, and many occluders have been made available since then. The ideal requirements of any procedure are a user-friendly technique, optimum success rate, no residual anomaly, minimal morbidity/mortality, and comparability or superiority to the existing conventional modality of treatment. With various advancements in device design, delivery and assisted systems, the tremendous procedural safety and effectiveness, along with low cost and widespread availability of these devices makes transcatheter closure of patent ductus arteriosus a preferred therapeutic modality in all age groups, with decreasing demographic trends of surgical management.     

巨大动脉导管未闭合并肺动脉高压患者介入封堵的可行性和有效性研究

目的应用封堵器治疗巨大动脉导管未闭（PDA）伴重度肺动脉高压（SPH）患者,并评价其临床疗效。方法回顾性分析26例巨大PDA合并SPH患者,应用封堵器封堵PDA,观察封堵前及封堵后肺动脉压力改变,术后随访6个月。结果 23例封堵成功,PDA最窄处直径8－18.0 mm,平均（12.2±4.6）mm。术前肺动脉收缩压为（98.3±23.4）mmHg,平均压为（69.1±15.0）mmHg,封堵后30分钟测肺动脉收缩压为（44.6±10.6）mmHg,平均压为（28.9±7.3）mmHg,较封堵前显著降低（P〈0.01）,3例PDA伴SPH者术中试封堵证实为阻力性肺动脉高压而放弃干预。封堵后30分钟降主动脉造影示22例封堵完全,无残余分流,1例存在中量残余分流。术后24小时超声心动图示1例仍存在微量残余分流,1个月后所有患者均未见残余分流,术后未见溶血、封堵器脱落、移位并发症。结论应用封堵器治疗巨大PDA伴SPH的患者是一种可行的、有效的介入方法。     

经食管超声心动图独立引导经股静脉途径封堵治疗儿童动脉导管未闭

目的 观察经食管超声心动图(TEE)独立引导经股静脉途径封堵治疗儿童动脉导管未闭(PDA)的价值。方法 收集25例接受TEE独立引导下经股静脉途径封堵治疗的PDA患儿(TEE组),并纳入接受X线引导下介入封堵治疗的70例PDA患儿(对照组),对比2组患儿一般资料、手术情况及随访资料，评估TEE引导下经股静脉途径封堵的疗效。结果 2组治疗效果均满意，封堵器位置均正常，周围无残余分流、无大血管梗阻。TEE组手术时间为28～61 min,对照组为28～62 min。组间患儿年龄、手术时间及住院时间差异均无统计学意义(P均>0.05)。治疗后1、3及6个月，2组封堵器位置均正常、动脉水平无残余分流、无心律失常；均未见明显并发症，无死亡病例。结论 TEE用于独立引导经股静脉途径封堵治疗儿童PDA安全、有效。     

Simultaneous transcatheter intervention for atrial septal defect complicated with patent ductus arteriosus: A 13-year single institutional retrospective study

Purpose: The feasibility and validity of simultaneous transcatheter interventions for patients with atrial septal defect (ASD) complicated with patent ductus arteriosus (PDA) has not been systematically evaluated.Materials and Methods: A retrospective analysis was conducted in patients who received transcatheter procedures for ASD complicated with PDA concurrently. The indications and treatment protocols were in accordance with the current guidelines. The sequence of therapy for ASD complicated with PDA was determined by clinical experience. Patients were followed up for at least 6 months after therapyResults: Overall, 22 patients received simultaneous transcatheter interventional therapy, and the success rate was a 100%. No severe complications transpired during the procedure or follow-up stage.Conclusion: Simultaneous transcatheter intervention is feasible and effective for patients who have concurrent complications for both ASD and PDA.     

经皮动脉导管未闭封堵术后左、右心室Tei指数的变化及其与心室重构的相关性

目的观察经皮动脉导管未闭(PDA)介入封堵术后心脏结构和心功能Tei指数的变化及其影响因素,探讨Tei指数与心房、心室重构的相关性及其临床意义。方法研究对象为我院施行PDA经导管封堵后的患者16例,并选择年龄相当的16例健康人作为对照组,应用超声心动图测定左、右心室Tei指数、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)和主动脉瓣血流速度峰值(Vp)等指标,并将PDA封堵术前后患者的左心室Tei指数的变化与LVEDD、LVEF、Vp等指标的变化作相关性分析。结果①PDA封堵成功率100%,封堵成功的患者均于术前、术后2天及3个月行经胸超声心动图检查和随访,均无残余分流和并发症,生活质量良好;②PDA患者术前左心室Tei指数较正常组显著升高(P<0.01),术后2天左心室Tei指数较术前显著升高(P<0.01),术后3个月左心室Tei指数恢复到正常范围内,PDA患者封堵术前后右心室Tei指数变化差异无统计学意义(P>0.05);③PDA封堵前LAD、LVEDD、LVESD、LVFS、LVEF、Vp均较正常对照组明显增大(P<0.05),术后2天均明显减小(P<0.05),术后3个月恢复到正常范围内,PDA封堵后右室舒张末期前后径(RVEDD)未见明显改变(P>0.05);④PDA封堵术后Tei指数的变化与LVEDD、LVEF及Vp的变化均呈显著的负相关(r分别为-0.528、-0.504、-0.515,均P<0.05),Tei指数与相应的R-R间期的变化无显著相关性。结论①介入封堵治疗后PDA患者Tei指数短期内均显著升高,于术后3个月恢复正常;②短期内Tei指数的变化与LVEDD、LVEF、Vp的变化呈负相关,Tei指数可以作为反映心功能变化的可靠的指标;③介入封堵治疗PDA患者通过纠正心脏的异常通道,可使心脏功能恢复正常。     

Asymptomatic patent ductus arteriosus in a 41-year-old woman

Patent ductus arteriosus is a rare adult congenital heart disease, especially asymptomatic cases are uncommon in older ages. We report here the case of a 41-year-old woman, who was incidentally found to have a patent ductus arteriosus. The patient also was asymptomatic. For anatomical demonstration, computerized tomography angiography was performed and then surgical intervention was applied.     

Aortic dissection with extension to a patent ductus arteriosus

An 81-year-old woman presented with shortness of breath and fever of 3 days duration. An enhanced CT of the chest revealed a patent ductus arteriosus (PDA) communicating with the true lumen of an aortic arch dissection. Neither the aortic dissection nor the PDA was suspected. The patient had no history of a connective tissue abnormality or other condition which would predispose to dissection other than systemic hypertension. It is likely that propagation of the aortic dissection partially re-opened the ductus arteriosus.     

电视胸腔镜辅助下胸膜外动脉导管未闭结扎术的护理

通过总结1997年9月－2000年9月在电视胸腔镜辅助下施行胸膜外动脉导管未闭结扎术治疗21例动脉导管未闭患的护理,认为重视术前心理护理和健康教育,加强术后血流动力学的监测以及呼吸道,引流管的护理,鼓励病人早期下床活动是该术式的护理重点,也是防止并发症发生,促进康复的有效措施。     

先心动脉导管未闭哑铃状弹簧栓子封堵治疗的体会

目的:应用pfm弹簧栓子封堵器经导管治疗动脉导管未闭并对其疗效进行初步评价。方法:在透视下经6F导管置入pfm哑铃状弹簧栓子,术后10min听诊,行右心导管检查及主动脉弓降部造影,术后48h行超声心动图及心脏x线平片检查评价治疗效果。X线结果:全组技术成功率为91.7％,1例发生并发症,11例术后心脏杂音即消失,3～6个月随访弹簧栓子无移位。无残余分流。结论:应用pfm弹簧栓子经导管治疗中小直径动脉导管未闭是安全有效的非手术方法,操作简便,成功率高,近期疗效可靠,中远期疗效尚待进一步观察。