经导管封堵治疗儿童动脉导管未闭

Transcatheter closure for patent ductus arteriosus in children

目的：观察不同封堵器治疗儿童动脉导管未闭（patent ductus arteriosus，PDA）的结果。方法：体检及经胸二维超声心动图（trans-thoracic echocardiograph，TTE）诊断为PDA的儿童，用原所报道过的方法作心导管检查、降主动脉造影及PDA封堵术。0．7～14岁的儿童行封堵术者78例，其中行螺旋弹簧（coil）治疗者16例；行Amplatzer duct occluder（ADO）治疗者9例；行国产PDA封堵器治疗者53例。结果：78例封堵成功，术后次日TTE检查，76例PDA完全堵塞，2例用coil堵塞者有少量残余分流。术前64例左室舒张末期内径增大者术后明显缩小。用ADO和PDA封堵器堵塞的62例无残余分流。3月末TTE检查，77例PDA完全堵塞，左室内径完全正常，1例用coil堵塞者仍有少量残余分流，且持续4年以上。追踪3—80[平均（30±8）]月，77例PDA完全堵闭，左室大小正常，降主动脉、左肺动脉口无明显狭窄，无封堵器械脱落。结论：用ADO，国产PDA封堵器和coil可安全有效地治愈儿童PDA。因创伤小，并发症少，远期无不良反应，可替代开胸手术。

Objective To evaluate the results of transcatheter closure for patent ductus arteriosus （ PDA ） by different devices in children. Methods Seventy- eight cases of PDA in children （ 7 months to 14 years old） , diagnosed by physical examination and transthoracic 2-dimensional echocardiography （TTE） , were included in the study. The examination included the cardiac catheterization, photograph of the thoracic aorta and conventional technique of PDA closure. Among these patients, 16 were treated with coils, 9 with Amplatzer duct occluder （ADO） , and 53 with native produced PDA occluders. Results TTE examination on the next day of the operation showed that PDAs were completely occluded in 76 cases, while the other 2 cases treated by coil had minimal residual shunt. Sixty-four patients, who were detected enlargement of the left ventricle before the operation, showed obvious diminishment of the cardiac size. By the end of 3 months, TTE examination showed that the closure of PDA was complete, and the left ventricle size was normal in 77 cases, while one case treated with coil had minimal residual shunt, which persisted for more than 4 years. The 3 - 80 months follow-up showed that the closure of PDA was complete in 77 cases, the configurations of the left ventricle, the thoracic aorta, and the left pulmonary artery were all normal. The occluders were well remained in situ. Conclusion The usual procedures of transcatheter closure for PDA are effective and safe with ADO, native produced occluders and coil in children. Interventional method, which shows minute insult, few complications, and few adverse effects, can substitute the thoracic surgery.