动脉导管未闭直径的不同测量方法在介入治疗中的应用

Comparative Study on Different Methods for Measurement of Diameter of Patent Ductus Arteriosus in Transcatheter Interventions

目的评价经胸超声心动图(TTE)与心血管造影在介入治疗中测量动脉导管未闭(PDA)直径的应用价值。方法拟行PDA堵闭的PDA患儿52例。应用TTE观察降主动脉与肺动脉间相通的动脉导管的位置、直径及长度,测量PDA最窄处直径;心血管造影选用猪尾管,行左侧位造影,测量其最窄径线。并对2种方法的测量值进行比较。采用SPSS12.0软件进行统计学分析。结果心血管造影显示52例PDA患者中,漏斗型45例,管型5例,漏斗型并管型、PDA结扎手术后残余分流各1例;TTE显示漏斗型46例,管型4例,窗型、PDA结扎手术后残余分流各1例。心血管造影测量的PDA直径为(3.72±2.51)mm,显著<TTE测量值(4.47±2.31)mm,二者比较差异具有显著性意义(t=5.17P<0.05)。结论TTE可用作术前病例的初步筛选,心血管造影决定PDA的分型,PDA直径需结合心血管造影与TTE测量综合分析,术后有无残余分流及随访依靠TTE。TTE与心血管造影在PDA介入治疗中互相补充,缺一不可。

Objective To evaluate the value of transthoracic echocardionraphy（TIE） and angiographic appearance for measurement of the diameter of patent ductus arteriosus （PDA） in transcatheter interventions. Methods In 52 patients, the position, diameter and length of ductus artefiosus between the descending aorta and the pulmonary artery were observed and the narrowest diameter of PDA was measured by TIE. In angiographic appearance ,pig catheter was selected to perform left lateral aortography and measure the narrowest diameter of PI）A. Comparative studies were performed on the numbers measured by 2 methods. Results Aortography showed that 45 patients had funnel shape PDA and 5 patients had tubular shape PDA,while 1 patient had funnel plus tubular shape PDA and 1 patient had residual shunt after operar tion. TIE showed that 46 patients had funnel shape PDA,4 patients had tubular shape PDA and 1 patient had window shape PDA, 1 patient had residual shunt after operation. The mean diameter of＇PDA measured by angiographic appearance was （3：72 ± 2.51 ） mm,which was statis- tically lower than those by TIE （4.47 ±2.31 ） mm （ t = 5.17 P 〈 0.05 ）. Conclusions TIE can he used primarily to select the patients for transeatheter interventions before operation. Classification of PDA is determined by angiographic appearance. The diameter of PDA is the result analysis of comprehensive measurement by TIE and angiographic appearance. Whether to have residual shunt and follow - up after closure relies on TIE. Thus＇TIE and angiographic appearance are complementary and indispensable in transcatheter interventionS.