The study on the application of pulmonary systemic blood volume ratio in transcatheter closure of patent ductus arteriosus patients with severe pulmonary hypertension

Zhong Yi; Liu Xiaoqiao

doi:10.13406/j.cnki.cyxb.003216

您当前的位置：

首页 >

文章列表页 >

The study on the application of pulmonary systemic blood volume ratio in transcatheter closure of patent ductus arteriosus patients with severe pulmonary hypertension

Clinical research | 更新时间：2025-10-21

- The study on the application of pulmonary systemic blood volume ratio in transcatheter closure of patent ductus arteriosus patients with severe pulmonary hypertension
- Journal of Chongqing Medical University Vol. 48, Issue 5, Pages: 597-601(2023)
- 作者机构：
  
  1.重庆市璧山区中医院心内科，重庆 402760
  2.贵州省人民医院心内科，贵阳 550000
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.003216
  CLC： R541.1
- Received：14 August 2022，
  
  Revised：2022-10-12，
  
  Accepted：07 December 2022，
  
  Published：28 May 2023
- 稿件说明：
移动端阅览
钟熠,刘晓桥.肺体循环血量比在动脉导管未闭合并重度肺动脉高压患者介入术中的应用研究[J].重庆医科大学学报,2023,48(5):597-601.

Zhong Yi,Liu Xiaoqiao.The study on the application of pulmonary systemic blood volume ratio in transcatheter closure of patent ductus arteriosus patients with severe pulmonary hypertension[J].Journal of Chongqing Medical University,2023,48(5):597-601.
钟熠,刘晓桥.肺体循环血量比在动脉导管未闭合并重度肺动脉高压患者介入术中的应用研究[J].重庆医科大学学报,2023,48(5):597-601. DOI： 10.13406/j.cnki.cyxb.003216.

Zhong Yi,Liu Xiaoqiao.The study on the application of pulmonary systemic blood volume ratio in transcatheter closure of patent ductus arteriosus patients with severe pulmonary hypertension[J].Journal of Chongqing Medical University,2023,48(5):597-601. DOI： 10.13406/j.cnki.cyxb.003216.

摘要

目的

对比分析行介入治疗的动脉导管未闭（patent ductus arteriosus，PDA）合并重度肺动脉高压（pulmonary artery hypertension，PAH）患者术前及术后血流动力学及心脏超声指标，探讨该类患者中肺体循环血量比（pulmonary to systemic flow ratio，Qp/Qs）与介入术后肺动脉压力改变、心脏结构恢复的相关性及预测价值。

方法

选取行介入封堵术的PDA合并PAH患者33例，根据术前Qp/Qs分为Qp/Qs≥2.5组（A组）及Qp/Qs<2.5组（B组），采集术前术后2组心导管检查获得的血流动力学参数，并记录术前术后随访的经胸超声心动图（transthoracic echocardiography，TTE）结果，对2组进行组内及组间对比分析。

结果

①术前2组间肺动脉收缩压（systolic pressure of pulmonary artery，sPAP）及肺动脉平均压（mean pressure of pulmonary artery，mPAP）无差异，术后即刻A组的sPAP及mPAP均低于B组。②A组的左心室舒张末期内径指数（left ventricular end diastolic diameter index，LVEDDI）、左心房内径指数（left atrial diameter index，LAI）、肺动脉内径指数（pulmonary artery diameter index，PAI）在术后48 h、术后1个月、术后3个月均较术前降低，B组仅PAI、LVEDDI在术后3个月较术前降低；术前2组间右心室舒张末期内径指数（right ventricular end diastolic diameter index，RVEDDI）无差异，术后3个月A组低于B组。③5例术后即刻残留重度PAH患者均发生于B组。其中1例患者靶向药物治疗效果显著。

结论

①对于合并重度PAH的PDA患者，Qp/Qs比值越大，术后肺动脉压力、心脏结构恢复越明显。②Qp/Qs对该类患者术后即刻残留重度PAH有一定预测价值。

Abstract

Objective

To compare and analyze the hemodynamics and cardiac ultrasound indexes before and after operation in patients with patent ductus arteriosus（PDA） complicated with severe pulmonary artery hypertension（PAH） who have undergone interventional treatment，so as to explore the correlation of pulmonary to systemic flow ratio（Qp/Qs） with pulmonary artery pressure change and cardiac structure recovery and predictive value of Qp/Qs after interventional treatment of such patients.

Methods

A total of 33 PDA patients complicated with PAH who had undergone interventional occlusion were divided into group A（Qp/Qs≥2.5） and group B（Qp/Qs<2.5） according to the preoperative Qp/Qs. The hemodynamic parameters obtained by cardiac catheterization before and after the operation were collected， and the results of transthoracic echocardiography（TTE） before and after the operation were recorded. The two groups were compared and analyzed.

Results

①There was no difference in systolic pressure of pulmonary artery（sPAP） and mean pressure of pulmonary artery（mPAP） between the two groups before operation. Immediately after operation，the sPAP and mPAP in group A were lower than those in group B. ②The left ventricular end diastolic diameter index（LVEDDI），left atrial diameter index（LAI） and pulmonary artery diameter index（PAI） in group A were lower than those before operation at 48 hours，1 month and 3 months after operation，while only PAI and LVEDDI in group B were lower than those before operation at 3 months after operation. There was no difference in right ventricular end diastolic diameter index（RVEDDI） between the two groups before operation， and group A was lower than group B 3 months after operation. ③Five patients with immediate residual severe PAH occurred in group B. Among them，targeted drug therapy was significantly effective in 1 patient.

Conclusion

①For PDA patients with severe PAH，the greater the Qp/Qs ratio，the more obvious the recovery of pulmonary artery pressure and cardiac structure after operation. ②Qp/Qs has a certain predictive value for the immediate residual severe PAH in these patients.

关键词

Keywords

references

Moş C . Patent ductus arteriosus [J ] . Med Ultrason ， 2010 ， 12 （ 2 ）： 153 - 156 .

Lopes AA ， O'Leary PW . Measurement，interpretation and use of haemodynamic parameters in pulmonary hypertension associated with congenital cardiac disease [J ] . Cardiol Young ， 2009 ， 19 （ 5 ）： 431 - 435 .

Baumgartner H ， Bonhoeffer P ， de Groot NM ， et al . ESC Guidelines for the management of grown-up congenital heart disease（new version 2010） [J ] . Eur Heart J ， 2010 ， 31 （ 23 ）： 2915 - 2957 .

张端珍，朱鲜阳，崔春生，等 . 动脉导管未闭并重度肺动脉高压封堵术后肺动脉压力变化 [J ] . 心脏杂志， 2014 ， 26 （ 6 ）： 708 - 712 .

Zhang DZ ， Zhu XY ， Cui CS ， et al . Changes of pulmonary artery pressure after transcatheter closure of patent ductus arteriosus complicated with severe pulmonary arterial hypertension [J ] . Chin Heart J ， 2014 ， 26 （ 6 ）： 708 - 712 .

Arvanitaki A ， Giannakoulas G ， Baumgartner H ， et al . Eisenmenger syndrome：diagnosis，prognosis and clinical management [J ] . Heart ， 2020 ， 106 （ 21 ）： 1638 - 1645 .

Shah JH ， Bhalodiya DK ， Rawal AP ， et al . Long-term results of transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in pediatric patients [J ] . Int J Appl Basic Med Res ， 2020 ， 10 （ 1 ）： 3 - 7 .

Barcroft M ， McKee C ， Berman DP ， et al . Percutaneous closure of patent ductus arteriosus [J ] . Clin Perinatol ， 2022 ， 49 （ 1 ）： 149 - 166 .

高　伟，顾　红，胡大一，等 . 2015年先天性心脏病相关性肺动脉高压诊治中国专家共识 [J ] . 中国介入心脏病学杂志， 2015 ， 23 （ 2 ）： 61 - 69 .

Gao W ， Gu H ， Hu DY ， et al . 2015 China expert consensus on diagnosis and treatment of congenital heart disease-related pulmonary hypertension [J ] . Chin J Interv Cardiol ， 2015 ， 23 （ 2 ）： 61 - 69 .

Brida M ， Nashat H ， Gatzoulis MA . Pulmonary arterial hypertension：closing the gap in congenital heart disease [J ] . Curr Opin Pulm Med ， 2020 ， 26 （ 5 ）： 422 - 428 .

曹黎明，金　波，王凤鸣，等 . 儿童动脉导管未闭合并中重度肺动脉高压介入治疗临床分析 [J ] . 南京医科大学学报（自然科学版）， 2016 ， 36 （ 12 ）： 1534 - 1537 .

Cao LM ， Jin B ， Wang FM ， et al . Clinical analysis of interventional therapy for patent ductus arteriosus complicated with moderate and severe pulmonary hypertension in children [J ] . J Nanjing Med Univ Nat Sci ， 2016 ， 36 （ 12 ）： 1534 - 1537 .

于　波，孔祥清，张智伟，等 . 中国动脉导管未闭介入治疗指南2017 [J ] . 中国介入心脏病学杂志， 2017 ， 25 （ 5 ）： 241 - 248 .

Yu B ， Kong XQ ， Zhang ZW ， et al . Guidelines for interventional therapy of patent ductus arteriosus in China 2017 [J ] . Chin J Interv Cardiol ， 2017 ， 25 （ 5 ）： 241 - 248 .

Huang JB ， Liu YL ， Yu CT ， et al . Lung biopsy findings in previously inoperable patients with severe pulmonary hypertension associated with congenital heart disease [J ] . Int J Cardiol ， 2011 ， 151 （ 1 ）： 76 - 83 .

Sadiq M ， Rehman AU ， Hyder N ， et al . Intermediate- and long-term follow-up of device closure of patent arterial duct with severe pulmonary hypertension：factors predicting outcome [J ] . Cardiol Young ， 2017 ， 27 （ 1 ）： 26 - 36 .

杨宏波，张戈军，唐永研，等 . 高海拔地区动脉导管未闭并发重度肺高压患者的经导管封堵疗效评价 [J ] . 岭南心血管病杂志， 2019 ， 25 （ 3 ）： 284 - 286，310 .

Yang HB ， Zhang GJ ， Tang YY ， et al . Effect of patients with patent ductus arteriosus complicated with severe pulmonary hypertension treated by transcatheter closure in high altitude area [J ] . South China J Cardiovasc Dis ， 2019 ， 25 （ 3 ）： 284 - 286，310 .

Kameny RJ ， Colglazier E ， Nawaytou H ， et al . Pushing the envelope：a treat and repair strategy for patients with advanced pulmonary hypertension associated with congenital heart disease [J ] . Pulm Circ ， 2017 ， 7 （ 3 ）： 747 - 751 .

Robert O Bonow ， Douglas L Mann ， Douglas P Zipes , 等 . Braunward心脏病学 [M ] . 9版 . 陈灏珠译. 北京：人民卫生出版社， 2018 ： 1726 - 1728 .

Bonow RO ， Mann DL ， Zipes DP , et al . Braunwald's Heart Disease [M ] . 9 th edition . Translated by Chen HZ. Beijing : People's Medical Publishing House , 2018 : 1726 - 1728 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

OPERATIVE TREATMENT OF 104 CASES OF PATENT DUCTUS ARTERIOSUS

SURGICAL TREATMENT OF THE PATENT DUCTUS ARTERIOSUS

Analysis on the efficacy of interventional therapy in the treatment of patent ductus arteriosus in children

Clinical evaluation of transcatheter closure of PDA with different type of devices

Related Author

李朝先

李法荫

李良彬

林尚清

张泽普

陈祥德

李朝先

李法荫

Related Institution

重庆医科大学第一医院胸外科

重庆医科大学第一医院胸心外科

重庆医科大学精神科

Department of Pediatrics

Department of Echocardiographic,the Affiliated Hospital of Luzhou Medical University

⁰