介入治疗儿童动脉导管未闭132例随访观察

Results of Follow-Up in 132 Children with Patent Ductus Arteriosus Treated by Transcatheter Therapy

目的了解介入治疗儿童动脉导管未闭(PDA)术后并发症的发生情况及其演变。方法通过询问病情及行胸片、心电图及心脏超声等辅助检查,对所完成的132例PDA患儿进行4a跟踪随访,随访时间为(28±16)个月。其中45例使用Amplatzer进口封堵器,87例使用深圳先健国产封堵器。结果术后第2天,经胸超声(TTE)证实128例封堵器位置良好,4例存在残余分流(4/132例),其中1例发生溶血(1/132例),经治疗后,症状消失。随访1个月,所有残余分流均消失。股动脉血栓形成1例(1/132例),经溶栓治疗,股动脉搏动完全恢复。9例出现短时间发热(9/132例)。随访过程中6例出现不明原因头痛。2例发生严重事件,1例术后6个月出现长期发热,TTE发现封堵器表面有赘生物形成,最终经外科开胸治疗痊愈。另1例于术后18个月死于不明原因的肺动脉高压。结论介入治疗儿童PDA是一种安全、有效方法,但同时也存在许多并发症,术后需认真而长期的随访观察。

Objective To assess the complications of transcatheter closure for patent ductus arteriosus （PDA） by devices in children. Methods Between Jun. 2001 and Dec. 2005,132 children （79 males and 53 females ） with PDA were treated for occlusion by means of percutaneous procedures. Average age was 32 months. Two different devices were nsed,45 eases with Amplatzer/or duetes arteriosus,87 cases with homemade devices. The average follow - up time was （28 ± 16） months. Results Transthoracic echocardiegraphy（TTE） examination on the next day of the operation showed that PDAs were completely occluded in 128 eases, while the other 4 eases had minimal residual shunt（4/132 eases） ,and 1 of them with hemolysis （1/132 eases ）. Nine eases with fever （9/132 eases）. During 1 month follow -up, ＇IrE examination showed that the closure of PDA was complete, the oceladers were well remained in situ, without residual shunt was found, and 6 cases complained of headache （6/132 cases）. Serious evens occurred in 2 cases. At the 6 months after the operation, 1 case had a long - time fever, with vegetations on the surface of the occluder by the TTE examination,and surgery operation was performed finally,the another one died from unknown pulmonary hypertension. Conclusions Transcatheter closure at PDA in children with different devices is safe and feasible, but the occluders will remaine in children body for all life. There needs a further investigation and careful follow - up study.