Occluder effects on platelet function of patients with congenital heart disease undergoing transcatheter closure

doi:10.3969/j.issn.2095-4344.2014.16.009

Abstract

Abstract:

BACKGROUND: Occluder implantation in patients with congenital heart disease can increase in vivo platelet adhesion and aggregation, resulting in thrombosis on the occluder surface.

OBJECTIVE: To investigate the effect of the occluder on platelet function in patients with congenital heart disease undergoing transcatheter closure.

METHODS: Clinical data from 124 patients with congenital heart disease undergoing transcatheter closure were retrospectively analyzed. These patients were divided into groups of atrial septal defect in 46 cases, patent ductus arteriosus in 43 cases and ventricular septal defect in 35 cases according to the types of congenital heart disease. The positive rates for peripheral blood CD_62p, CD₆₃ and thrombin sensitive protein were compared before and 6 hours, 24 hours, 12 months after occluder implantation.

RESULTS AND CONCLUSION: There was no difference in the positive rates of peripheral blood CD_62p, CD₆₃ and thrombin sensitive protein among three groups prior to occluder implantation. Up to 6 hours after occluder implantation, the expression levels of peripheral blood CD_62p, CD₆₃ and thrombin sensitive protein reached peak in the three groups, especially in the patients with atrial septal defect and ventricular septal defect, then gradually decreased. After 12 months, the expression levels of CD_62p and CD₆₃ recovered in the patients with patent ductus arteriosus and ventricular septal defect, but still maintained a higher level in those with atrial septal defect (P < 0.05). The expression of thrombin sensitive protein showed no difference among the three groups at different time. These findings indicate that after occluder implantation, the platelet activation is more remarkable and lasts longer in the patients with atrial septal defect and ventricular septal defect, especially in those with ventricular septal defect.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: septal occluder device, heart diseases, platelet activation, thrombospondins

CLC Number:

R318

Chen Lin, Yan Hua, Chen Li-yuan, Lu Yong-guang, Fu Chun-hui, Zheng Zhan-chuan. Occluder effects on platelet function of patients with congenital heart disease undergoing transcatheter closure[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(16): 2512-2518.

Figures/Tables 3

2.3 各组血小板表面活化标志物蛋白表达水平的比较封堵器置入前3组患者3种血小板表面活化标志物的蛋白表达无明显区别，封堵后6 h有进一步的升高，封堵后24 h 3组均有明显回落，封堵后12个月3组水平均又有明显下降，动脉导管未闭组、室间隔缺损组回落至封堵前水平，但房间隔缺损组CD62p、CD63表达水平仍维持相对较高水平，具体结果见表2。房间隔缺损组：①CD63：封堵后6 h高于封堵前(P < 0.05)，封堵后24 h与封堵后6 h比较差异无显著性意义(P > 0.05)，封堵后12个月低于封堵后24 h(P < 0.05)。②CD62p：封堵后6 h高于封堵前(P < 0.05)，封堵后24 h低于封堵后6 h(P < 0.05)，封堵后12个月与封堵后24 h比较差异无显著性意义(P > 0.05)。③凝血酶敏感蛋白：封堵后6 h高于封堵前(P < 0.05)，封堵后24 h低于封堵后6 h(P < 0.05)，封堵后12个月与封堵后24 h比较差异无显著性意义(P > 0.05)。动脉导管未闭组：①CD63：封堵后6 h与封堵前、封堵后24 h与封堵后6 h、封堵后12个月与封堵后24 h比较差异均无显著性意义(P > 0.05)。②CD62p：封堵后6 h高于封堵前(P < 0.05)，封堵后24 h与封堵后6 h、封堵后12个月与封堵后24 h比较差异均无显著性意义(P > 0.05)。③凝血酶敏感蛋白：封堵后6 h高于封堵前(P < 0.05)，封堵后24 h低于封堵后6 h(P < 0.05)，封堵后12个月低于封堵后24 h(P < 0.05)。室间隔缺损组：①CD63：封堵后6 h高于封堵前(P < 0.05)，封堵后24 h与封堵后6 h比较差异无显著性意义(P > 0.05)，封堵后12个月低于封堵后24 h(P < 0.05)。②CD62p：封堵后6 h高于封堵前(P < 0.05)，封堵后24 h低于封堵后6 h (P < 0.05)，封堵后12个月低于封堵后24 h(P < 0.05)。③凝血酶敏感蛋白：封堵后6 h高于封堵前(P < 0.05)，封堵后24 h低于封堵后6 h(P < 0.05)，封堵后12个月与封堵后24 h比较差异无显著性意义(P < 0.05)。组间比较：①封堵后6 h，房间隔缺损组与动脉导管未闭组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异有显著性意义，室间隔缺损组与动脉导管未闭组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异有显著性意义，房间隔缺损组与室间隔缺损组组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异无显著性意义(P < 0.05)。②封堵后24 h，房间隔缺损组与动脉导管未闭组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异有显著性意义，室间隔缺损组与动脉导管未闭组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异有显著性意义，房间隔缺损组与室间隔缺损组组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异无显著性意义(P < 0.05)。③封堵后12个月，房间隔缺损组与动脉导管未闭组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异有显著性意义，房间隔缺损组与室间隔缺损组组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异有显著性意义，室间隔缺损组与动脉导管未闭组CD62p、CD63、凝血酶敏感蛋白表达组间两两比较差异无显著性意义(P < 0.05)。 2.4 术后心脏多普勒超声检查结果及相应的典型病例图由术前心脏多普勒超声检查可知，各组封堵器的选择具有很好的适应性和相关性，见图1-3所示。手术成功，在手术中监测封堵器的位置固定，且对主动脉瓣、腔静脉、房室瓣以及肺动脉瓣、冠状静脉窦无明显影响，没有出现残余分流、新增心包积液情况。手术后经过近12个月的随访可知：患者封堵器稳固，没有出现移位、脱落等不良现象，经彩色多普勒血流检查可知没有出现残余分流情况，疗效显著，部分患者扩大的心腔明显回缩。"

References

[1] Rashkind WJ,Miller WW.Creation of an atrial septal defect without thoracotomy. JAMA.1966;196(11):991-992.
[2] 王广义,王峙峰,郭军,等.经导管介入封堵老年继发孔型房间隔缺损[J].心脏杂志,2004,16(专刊):S71-S72.
[3] Sarris GE,Kirvassilis G,Zavaropoulos P,et al.Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association.European Journal of Cardio-Thoracic Surg.2010;37(6):1285-1290.
[4] Prsa M,Ewert P.Transcatheter closure of a patent ductus arteriosus in a preterm infant with an Amplatzer Vascular Plug IV device.Catheter Cardiovasc Interv.2011;77(1):108-111.
[5] 谭大伟,朱平,李小鹰.氯吡格雷抑制血小板功能的两种检测方法比较:血小板聚集实验与血小板膜糖蛋白检测[J].中国组织工程研究与临床康复,2007,11(11):2021-2024.
[6] 曾秋棠,毛晓波.先天性心脏病介入治疗的现状[J].临床心血管病志,2006,22(5):257- 258.
[7] 高宏,蔡振杰.婴儿先天性心脏病125例外科治疗[J].临床和实验医学杂志,2011,10(2):99-100.
[8] 谢周良,苑星,杨志远.先天性心脏病三种体外循环手术美容切口的比较[J].实用儿科临床杂志,2002,17(5):510-511.
[9] 郑林琼,张伟华,鲁一兵,等.动脉导管未闭封堵术后血小板减少10例临床分析[J].中国介入心脏病学杂志,2012,21(5):275-277.
[10] Hamrick SEG,Hansmann G.Patent ductus arteriosus of the preterm infant. Pediatrics.2010;125(5):1020-1030.
[11] 刘俊香,刘燕,翟怀鸿.超声心动图在先天性心脏病封堵术中的应用11 例分析[J].中国误诊学杂志,2009,9(19):4763-4764.
[12] 王志远,金梅.Amplatzer与国产封堵器经皮介入治疗室间隔缺损的临床应用现状[J].心肺血管病杂志,2010,29(1):77-79.
[13] 张贵,张德元,何伶俐,等.纳米结构Ti/TiN涂层对NiTi合金生物相容性的影响[J].现代生物医学进展,2009,9(13):2465-2468.
[14] 张晓群,郭泰,芦芳.彩色多普勒血流显像技术评价先天性心脏病介入封堵术前后心脏形态及功能变化[J].临床医药实践,2010, 19(8):570-572.
[15] Thanopoulos BV,Eleftherakis N,Tzannos K,et al.Further experience with catheter closure of patent ductus arteriosus using the new Amplatzer duct occluder in children.Am J Cardiol. 2010;105(7):1005-1009.
[16] 谢绍峰,赖昀掞,朱恒青,等.国产封堵器封堵治疗先天性心脏病106例[J].中国组织工程研究与临床康复,2009,13(17):3285- 3288.
[17] 卢竞前,吕云,李易.与动脉导管未闭介入封堵相关的血小板减少症三例临床分析[J].中国介入心脏病学杂志,2010,18(5):299- 300.
[18] 吴顺芬,陈刚.小儿先天性心脏病的治疗进展:国产封堵器的应用及评价[J].中国组织工程研究与临床康复,2009,13(35):6907- 6910.
[19] 许愿愿,张伟华,左明鲜,等.先天性心脏病介入治疗855例临床疗效分析[J].昆明医学院学报,2010,31(8):131-133.
[20] 陈世忠,张林潮.国产封堵器介入治疗先天性心脏病80例[J].实用心电学杂志,2009,18(2):128-130.
[21] 胡楝,钟志敏,钟焕清,等.应用Amplatzer封堵器介入治疗继发孔房间隔缺损199例疗效观察[J].广东医学院学报,2011,29(1):65.
[22] 张黄健.介入治疗先天性心脏病52例临床分析[J].中外医疗, 2009, 28(8):36.
[23] 郝金玲,王育林.经胸超声指导封堵器介入治疗先心病24例分析[J].中国厂矿医学,2009,22(1):62.
[24] 韩琼.介入封堵治疗在先天性心脏病的应用[J].医学信息(上旬刊), 2011,24(7):4689-4690.
[25] 郭维琼,钱维源,安平,等.超声协助介入封堵治疗先天性心脏病4例[J].东南国防医药,2009,11(3):245-246.
[26] 方臻飞,李丽,沈向前,等.生物陶瓷膜先天性心脏病封堵器与普通镍钛合金封堵器的比较:随机对照[J].中国组织工程研究与临床康复,2011,15(34):6296-6301.
[27] 万金香.经胸超声心动图在ASD、VSD、PDA介入封堵中的应用[J].现代医药卫生,2009,25(8):1154-1155.
[28] 孙厉文,冯俊,常凤玲.心脏彩超监测及评价先心病介入治疗的应用价值[J].中国实用医药,2010,5(35):29-30.
[29] 张云涛,郭立新,金敬琳.介入封堵在治疗室间隔缺损修补术后残余漏上的疗效[J].心脏杂志,2013,6(1):57-59.