动脉导管未闭介入封堵术后血小板急剧减少三例

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1、动脉导管未闭介入封堵术后血小板急剧减少三例ThreeCasesReportaboutPlateletDecreasedSharplyaftertheInterventionalClosureofPatentDuctusArteriosus例1患者男性，9岁，因劳力性气促9年入院。经超声心动图及X线胸片等检查诊断为动脉导管未闭（Patentductusarteriosus，PDA）。Case1Anine-year-oldmalepatientwashospitalizedbecauseofexertionalpolypneafornineyears.hewasdiagnos

2、edpatentductusarteriosus(PDA）byechocardiographyandX-raychestradiographyexamination.入院后查血常规示：血小板为136.00×109/L，红细胞为4.60×1012/L，嗜酸性粒细胞计数为0.30×109/L。术中测肺动脉收缩压为90mmHg（1mmHg=0.133kPa），舒张压为49mmHg，平均压为62mmHg。Afteradmission,checkingroutinebloodshowed:thrombocyte136.00×109/L，erythrocyte4.60×1012/L,

3、eosinophilicgranulocyte0.30×109/L。duringoperation,thesystolicpulmonaryarterypressurewas90mmHg（1mmHg=0.133kPa）diastolicbloodpressurewas49mmHg,averagepressurewas62mmHg.造影示：巨大PDA（呈管状，最窄处直经为26mm），主动脉弓降部直径为32mm。因无相应大小的PDA封堵器，遂用32mm房间隔封堵器试行封堵。封堵即刻，测肺动脉收缩压为52mmHg，舒张压为21mmHg，平均压力为31mmHg，但试封堵后数分钟，

4、封堵伞即自行脱位，遂取出封堵器，终止手术。在。。。的当时Pulmonaryandaortaangiographyshowed:giantPDA(tubularshape,diameterofthenarrowestplaceis26mm),theaorticarchdescendingsegmentdiameterwas32mm.BecausetherewasnosuitablesizeofPDAoccluder,wetriedtouseinteratrialseptumdefectoccludertoclosuretheductoccluder.Atthetimeofp

5、lugging,systolicpulmonaryarterypressurewas52mmHg,diastolicbloodpressurewas21mmHg，theaveragepressurewas31mmHg，butafewminutesaftertheplugging,theduct11occluderimmediatelyfalloffautomatically.Then,wetooktheoccluderout,andterminatedtheoperation.7d后采用特制的32mmPDA封堵伞（上海形状记忆合金材料公司）再次封堵成功，但术后即刻造影示：

6、封堵器内可见明显的滤过血流。Sevendayslater,weclosuredthePDAsuccessfullybyusingspeciallymade32mmductoccluder(Shanghaishapememoryalloymaterialscompany),butitcouldbeseenthatfiltrationbloodflowranthroughtheductoccluderobviouslybyimmediatelypostoperativeangiograph.术后即刻测肺动脉收缩压为55mmHg，舒张压为25mmHg，平均压为34mmHg。患者

7、有气促症状，术后48h复查血常规示：血小板为30.00×109/L，红细胞为4.09×109/L，嗜酸性粒细胞计数为0.30×109/L。Immediatelyaftertheoperation,wemeasuredsystolicpulmonaryarterypressurewas55mmHg,diastolicbloodpressurewas25mmHg,themeanbloodpressurewas34mmHg.Thepatienthadtachypneasymptoms.Forty-eighthoursafterthe