Correlative Study Of Pulmonary Artery Pressure Associated With Patent Catheterization Of Congenital Heart Disease

Objectives:To the treatment of congenital heart disease with patent ductus arteriosus in patients undergoing occlusion and related examination methods,the assessment of pulmonary arterial pressure changes is performed by observing the patient's preoperative and postoperative cardiac ultrasound and right heart catheterization as the main detection methods.Preoperative and postoperative pressure changes provide insights for interventional treatment strategies,optimize surgical indicators,and increase patient benefit.Methods:116 cases of PDA patients admitted to the Department of Cardiology at Yan'an Hospital of Kunming City from December 2015 to December 2017 were randomly selected as the study subjects.There were 39 males and 77 females,aged 1 to 68 years,weighing 7.5.?70 kg,preoperative clinical examination,cardiac ultrasound,cardiac catheterization and other tests confirmed the patent ductus arteriosus(PDA),and percutaneous transcatheter closure of the indication for patent ductus arteriosus.Preoperative recording of pulmonary artery systolic pressure,left ventricular and right ventricular diameter,and left ventricular ejection fraction in the patient's echocardiogram;intraoperative and postoperative right heart catheterization to record pulmonary artery pressure;48-72 hours postoperative echocardiography The figure records the left ventricle,the right ventricle and the left ventricle ejection fraction.The data were compared before and after and statistical analysis of linear regression.Results:All 116 patients were confirmed by arteriography with patent ductus arteriosus.All patients underwent right heart catheterization during surgery.76 patients with mean pulmonary artery pressure ?25 mmHg were considered to have pulmonary hypertension.Among them,4 patients considered severe pulmonary hypertension,and pulmonary arterial pressure increased after the blockage was given.No pulmonary arterial pressure was decreased after pulmonary artery nitroglycerin injection and oxygen inhalation.Considered resistance pulmonary hypertension,it was not blocked..Patients with average pulmonary artery pressure<25 mmHg were 40 patients.Except for 4 patients who failed to undergo occlusion,112 patients were treated with Amplatzer occluder or homemade PDA mushroom umbrella occluder to block PDA and the occlusion was successful.All patients undergoing transcatheter closure showed that the occluder lumbar sign was obvious under X-ray.Postoperative aortic angiography showed no shunt or only a small amount of shunt,and the shunt passed through the occluder.Preoperative echocardiographic evaluation of pulmonary arterial systolic pressure was 47.41 ±21.62 mmHg.The pulmonary arterial systolic pressure measured by the right heart catheter was 47.72±23.07 mmHg.There was no statistical difference(P>0.05).The preoperative pulmonary artery systolic pressure in 4 patients without occlusion was 105.25± 10.68 mmHg,and the average pulmonary artery pressure was 80.75±4.85 mmHg.The postoperative contractile pressure was 122.5±9.57 mmHg and the average pressure was 89.50±7.59 mmHg.Before and after the pressure was significantly higher(P<0.05).The measured pulmonary resistance was 20.61±9.05 wood.In the remaining 72 patients with pulmonary hypertension,the pulmonary arterial systolic pressure was measured to be 57.61±22.88 mmHg before and after the blockade,and 38.68± 12.44 after the blockage;the average pulmonary artery pressure was 41.22± 17.47 mmHg before operation,and 26.22±9.76 after the operation.mmHg;Postoperative pressure values were significantly reduced(P<0.05).In 112 patients with successful PDA occlusion,preoperative and postoperative left and right ventricle end-diastolic diameters were calculated.The right ventricular diameter was reduced by 1.09±3.92mm,and the left ventricular diameter was reduced by 4.65±3.85mm.At the same time,according to the right heart catheterization record of preoperative and postoperative pulmonary artery pressure reduction,the pulmonary artery systolic pressure decreased by 14.68± 13.28 mmHg,and the average pulmonary artery pressure decreased by 10.20± 11.35 mmHg.Linear correlation analysis was given respectively,which suggested that the amplitude of pulmonary artery systolic pressure was positively correlated with the contraction amplitude of right and left ventricle(P<0.05),and the decrease of pulmonary artery pressure was positively correlated with the contraction amplitude of left ventricle(P<0.05).Conclusion:1.Preoperative observation of pulmonary arterial pressure in patients with PDA has important implications for the choice of patient treatment.Ultrasound-estimated pulmonary artery systolic pressure has high accuracy,and is non-invasive and simple and quick.2.It is of great significance to determine the pulmonary hypertension in patients after try-apeal closure is dynamic pulmonary hypertension or resistance pulmonary hypertension.3.Patients undergoing interventional PDA closure can gradually improve heart function.Observing closely the preoperative and postoperative pulmonary artery pressure changes is of great significance in assessing the success and prognosis of the patients.