CAJ | 학술논문

目的探讨室间隔缺损(VSD)封堵器在介入治疗婴幼儿粗大动脉导管未闭(PDA)中的临床应用和安全性.方法 2008年6月-2009年5月,应用对称膜部VSD封堵器对5例婴幼儿粗大PDA合并重度肺动脉高压的患儿进行介入封堵治疗.男1例,女4例,年龄5个月～3岁,体重5.1～15.0 kg,体表面积(BSA)0.37～0.58 m2.动脉导管呈类似管型,内径5.7～8.5 mm,肺血管阻力4.8～5.7 Wood单位,体循环血量比(Qp/Qs)为3.4～4.6.术后3例患儿接受波生坦治疗.结果 5例患儿全部封堵成功,术后4～5天出院.其中1例患儿选用膜部VSD封堵器,其余4例选用肌部VSD封堵器.5例患儿多汗症状明显改善,体重增加明显.复查超声心动图示封堵器位置固定、无残余分流,无左肺动脉及降主动脉狭窄;根据三尖瓣和肺动脉瓣反流估测肺动脉压力均有不同程度下降,随访6个月以上的患儿肺动脉压均降至正常水平.结论对于合并动力性肺动脉高压的婴幼儿粗大PDA,由于导管粗大及弓降部内径限制,应用VSD封堵器封闭动脉导管是一种较为安全的选择,但需更大样本量的病例和长期随访积累.
목적 탐토실간격결손(VSD)봉도기재개입치료영유인조대동맥도관미폐(PDA)중적림상응용화안전성.방법 2008년6월-2009년5월,응용대칭막부VSD봉도기대5례영유인조대PDA합병중도폐동맥고압적환인진행개입봉도치료.남1례,녀4례,년령5개월～3세,체중5.1～15.0 kg,체표면적(BSA)0.37～0.58 m2.동맥도관정유사관형,내경5.7～8.5 mm,폐혈관조력4.8～5.7 Wood단위,체순배혈량비(Qp/Qs)위3.4～4.6.술후3례환인접수파생탄치료.결과 5례환인전부봉도성공,술후4～5천출원.기중1례환인선용막부VSD봉도기,기여4례선용기부VSD봉도기.5례환인다한증상명현개선,체중증가명현.복사초성심동도시봉도기위치고정、무잔여분류,무좌폐동맥급강주동맥협착;근거삼첨판화폐동맥판반류고측폐동맥압력균유불동정도하강,수방6개월이상적환인폐동맥압균강지정상수평.결론 대우합병동력성폐동맥고압적영유인조대PDA,유우도관조대급궁강부내경한제,응용VSD봉도기봉폐동맥도관시일충교위안전적선택,단수경대양본량적병례화장기수방적루.
Objective To observe the availability and safety of ventricular septal defect (VSD) occluder in infants and young children with large patent ductus arteriosus (PDA) associated with severe pulmonary hypertension.Methods Five patients (1 male and 4 fomale) of large PDA aged 5 months to 3 years,weighted from 5.1 to 15 kg,body surface area (BSA) 0.37-0.58 m2 underwent transcathter intervention with concentric VSD occluders from June 2008 to May 2009.Arterial ducta were tube-like and their diameters were 5.7 to 8.5 mm,with ulmonary vascular resistance from 4.8 to 5.7 Wood Unit,Qp/Qs 3.4-4.6.Three patients were given Bosentan after intervention.Results The large PDAs were successfully closed with VSD occluders,including 1 concentric perimembranous VSD occluder and 4 muscular VSD occluders.They all discharged 4 to 5 days with hidrosis and weight improved.Echocardiogram indicated VSD occluder was stable,no residue shunt and no stricture of left pulmonary artery and descending aorta were found.According to tricuspid and pulmonary regurgitation,pulmonary arterial pressure decreased differently and returned to normal after 6 months follow-up.Conclusion VSD occluder is available and effective to close large PDA associated with severe pulmonary hypertension in inrants and young children,but more cases and long-term follow-up are necessary.