经导管封堵动脉导管未闭介入治疗后残余分流Transcatheter occlusion of residual shunt after interventional therapy of patent ductus arteriosus
李俊杰,张智伟,王慧深,钱明阳,李渝芬,曾国洪
摘要(Abstract)：
目的探讨经导管封堵动脉导管未闭(PDA)介入治疗后残余分流的可行性和临床疗效。方法自1997年3月至2001年8月16例PDA介入治疗后残余分流的患者,其中男4例,女12例,平均年龄5.9±2.4岁(2～9岁),平均体重17.7±5.4kg(9～28kg),应用不同介入方法经动脉或静脉途径封堵残余分流,首次介入治疗与再次介入治疗的时间间隔平均为1.5±1.1年(1天～3.5年)。结果残余分流直径平均为2.7±0.9mm(1.2～5.0mm)。15例成功完成残余分流封堵术,1例失败,技术成功率为94%(15/16)。单纯应用Cook可控弹簧圈9例(其中双弹簧圈2例),Rashkind双面伞2例,Sidris纽扣式补片1例,Amplatzer蘑菇伞2例,同时应用Cook可控弹簧圈和Sidris纽扣式补片1例。封堵术后即刻造影,3例仍有少量残余分流,完全闭合率为80%(12/15)。平均手术时间为75.0±22.8min(45～120min),平均X线透视时间为10.4±3.9min(5～20min)。股动脉并发症1例,其余无并发症出现。封堵术后24h复查超声心动图,所有残余分流均完全闭合(100%),在平均2年随访中未出现残余分流再通、封堵器移位和左右肺动脉狭窄。结论经导管封堵PDA介入治疗后残余分流安全、疗效确切、创伤小,可作为外科手术治疗PDA介入治疗后残余分流的一种替代方法。
关键词(KeyWords)： 动脉导管未闭;心脏导管插入术
基金项目(Foundation):
作者(Author): 李俊杰,张智伟,王慧深,钱明阳,李渝芬,曾国洪
参考文献(References)：
- 1RashkindWJ,MullinsCE,HellenbrandWE,etal.Nonsurgicalclosureofpatentductusarteriosus:clinicalapplicationoftheRashkindPDAOccluderSystem.Circulation,1987,75:583592.
- 2RaoPS,SiderisEB,HaddadJ,etal.Transcatheterocclusionofpatentductusarteriosuswithadjustablebuttoneddevice.Circulation,1993,88:11191126.
- 3LloydTR,BeekmanRH,MooreJW,etal.ThePDAcoilregistry.Reportofthefirst535procedures.Circulation,1995,92(Suppl1):I380(abstract).
- 4MasuraJ,WalshKP,ThanopeulousB,etal.Catheterclosureofmoderate to largesizedpatentductusarteriosususingthenewAmplatzerDuctOccluder:immediateandshort termresults.JAmCollCardiol,1998,31:878882.
- 5TynanM,HuggonI,AnjosR,etal.Transcatheterocclusionofpersistentarterialduct.Lancet,1992,340:10621065.
- 6HuggonIC,TabatabaeiAH,QureshiSA,etal.UseofasecondtranscatheterRashkindarterialductoccluderforpersistentflowafterimplantationofthefirstdevice:indicationsandresults.BrHeartJ,1993,69:544550.
- 7MooreJW,GeorgeL,KirkpatrickSE.ClosureofresidualpatentductusarteriosuswithoccludingspringcoilafterimplantofaRashkindoccluder.AmHeartJ,1994,127:943945.
- 8LatsonLA.Residualshuntsaftertranscatheterclosureofpatentductusarteriosus:Amajorconcernorbenign“Techno malady”.Circulation,1991,84:25912593.
- 9BalzerLA,SprayTL,McMullinD,etalEndarteritisassociatedwithaclinicallysilentductusarteriosus.AmHaertJ,1993,125:11921193.
- 10HoskingMCK,BensonLN,MuseweN,etal.Transcatheterocclusionofthepersistentlypatentductusarteriosus.Circulation,1991,84:23132317.
- 11CambierPA,KirbyWC,WorthamDCetal.Percutaneousclosureofthesmallpatentductusarteriosususingcoilembolization.AmJCardiol,1992,69:815816.