1About transcatheter closure treatment of patent ductus arteriosus and severe pulmonary hypertension (report of 2 cases)Keywords patent ductus arteriosus cardiac catheterization hypertension pulmonary treatment outcomes Patent ductus arteriosus (PDA is one of the common congenital heart disease, previous thoracotomy ligation as the only method of treatment, while severe pulmonary High-pressure patients, the elderly PDA surgical risk. Division since 2002 transcatheter closure therapy has successfully treated more than 90 cases of PDA patients, which Two cases complicated by severe and severe pulmonary hypertension, interventional occlusion treatment achieved the desired results, are as follows. 1 Clinical data Example 1, female, 32 years old. Suffering PDA with severe pulmonary hypertension, cardiac surgery transferred. Admission blood pressure 16.6/10.6 kPa, heart rate 86 min-1, law Qi, P2 hyperthyroidism, left sternal border the 2second intercostal smell and 4/6 systolic ejection murmur. Echocardiography: PDA, left to right shunt, left ventricular end-diastolic Inside diameter (LVEDD6.3 cm, left ventricular ejection fraction (LVEF0.60 to estimate the pulmonary artery systolic pressure of 15.2 kPa. Surgery descending aortic angiography showed PDA The trails 10 mm, measured the aorta and pulmonary artery pressure and for 17.0/8.0/11.0 kPa, 14.6/8.3/10.4 kPa since the femoral vein to send the delivery sheath to the descending aorta Send along the sheath diameter of 18 20 mm Amplazer PDA umbrella closure waist at the narrowest in the PDA occluder fixed auscultation murmur disappeared immediately after closure lung Arterial pressure 8.7/3.2/4.9 kPa was measured 15 min after the aorta and pulmonary artery pressure as 18.1/11.3/13.6 kPa, 6.7 / 2.7/4.0 kPa, re- Complex descending aortic angiography without shunt release PDA umbrella. Postoperative follow-up of 2 years, patients with no symptoms, echocardiography icon LVEDD was 4.6 cm, the pulmonary artery pressure is 3Often. Example 2, female, 53 years old admitted to hospital due to acute left ventricular failure, admission diagnosis of dilated cardiomyopathy. Echocardiography confirmed as PDA after admission. Vasodilator Lee Urinary and cardiac treatment, his condition is stable. Examination: 18.7/9.3 kPa blood pressure, heart rate 118 min-1, the law is absolutely not the whole, P2 hyperthyroidism, left sternal ribs 2 Between Wen and 3/6 systolic ejection murmur. ECG revealed: atrial fibrillation. Echocardiography icon: PDAs, systolic left-to-right shunt heart to expand, LVEDD was 8.6 cm, LVEF 0.33 estimate pulmonary artery systolic pressure of 15.5 kPa surgery descending aorta angiography showed PDA minimum diameter 7 mm, measured aortic and pulmonary Arterial pressure were and for 19.3/9.3/12.7 kPa, 17.7/6.7/10.4 kPa send delivery sheath from the femoral vein to the descending aorta to send along the sheath 12 14 mm in diameter PDA umbrella closure waist, the narrowest point in the PDA occluder fixed, auscultation murmur 4disappeared, the heart rate dropped to 90 min-1, patients with palpitations, shortness of breath symptoms improved significantly; Aorta and pulmonary artery pressure was measured after 15 min for 25.3/10.0/15.1 kPa 10.8/4.0/6.8 kPa. Repeated descending aorta angiography without shunt release PDA umbrella. Postoperative I nitrate Gan Youjing drops, Capoten blood pressure oral dynasties, and follow-up of 5 months, the patients heart function two echocardiography icon heart chamber was significantly reduced. LVEDD of 5.4 cm, and pulmonary artery systolic pressure of 5.3 kPa. Links to free papers Download Center http:/eng.hi138.com2 discussion Intervention method for the treatment of PDA, PDA with severe pulmonary hypertension, the difficulty and risks of surgical ligation has been the difficulty of the surgical treatment. Patient Older, catheter thicker wall thinning, fibrosis and 5increased brittleness, easy bleeding related to poor prognosis with surgery. Correct evaluation of the PDA patients lung Reversibility of arterial hypertension is critical, inappropriate to close the PDA can lead to increased mortality. Surgical ligation is difficult to estimate the reversibility of pulmonary hypertension, This pair may be organic severe pulmonary hypertension patients will have serious adverse consequences 1-3. Interventional therapy with trauma, fewer complications, recovery faster, shorter hospital stay, and PDA patients with severe pulmonary hypertension, may first Closure of the line test, that is before and after closure, the dynamic measurement of pulmonary artery and aortic pressure, organic severe pulmonary hypertension patients, recyclable occluder, thus avoiding On contraindications surgery. Believe that the trial closure after pulmonary artery pressure more than 4 kPa or 20% reduction in aortic pressure and oxygen saturation did not fall or slightly elevated, as 6The release of the occluder indic