蘑菇伞封堵器介入治疗婴幼儿动脉导管未闭的临床疗效研究

Catheter closure of patent ductus arteriosus by mushroom shape occluder in infants

目的:评价蘑菇伞封堵器经导管介入治疗婴幼儿动脉导管未闭(patent ductus arteriosus,PDA)的临床疗效.方法:2002-12/2008-06我科对婴幼儿PDA 78(男28,女50)例实施经导管介入治疗,年龄8～36(15.8±5.6)mo,体质量7.8～17.5(12.0±4.3)kg;行右心导管检查测定肺动脉压力、主动脉压力,行主动脉弓降部造影,确定PDA位置、形状及大小,PDA最窄处内径1.5～14.3(4.3±3.1)mm.以蘑菇伞堵堵器行介入治疗.术后24 h及1,3,6,12 mo行彩色多普勒超声心动图检查.结果:78例患儿中74例(94.9%)封堵器植入成功.1例主动脉造影后PDA粗大(14.3 mm),呈C型,采用最大型号封堵器轻易拉过PDA,该例放弃封堵术,转外科手术治愈.1例为PDA封堵器主动脉侧过大,导致降主动脉局部狭窄、迂曲变形而放弃封堵.1例PDA并发重度肺动脉高压试封堵后30 min肺动脉收缩压无下降,反而有轻度上升,考虑为阻力性重度肺动脉高压,撤出封堵器.1例封堵术后封堵器周围大量残余分流,行外科手术治疗.余74例术后30 min主动脉弓降部造影显示52例(70.3%)封堵完全,22例(29.7%)可见极少量残余分流,术后24 h心脏彩超复查71例(95.9%)封堵完全,3例(4.1%)有少量残余分流,术后1 mo彩超复查皆无残余分流;无再通和堵闭器移位等并发症发生.结论:在严格选择适应证的条件下,应用蘑菇伞经导管封堵治疗婴幼儿PDA是一种安全、简便、有效、创伤小、恢复快的方法,值得推广应用.

AIM： To evaluate the treatment efficiency of catheter closure of patent ductus arteriosus （PDA） by mushrooms occluder in infants. METHODS： Seventy-eight cases of infant PDA （28 males and 50 females ） underwent attempted catheter closure by using mushroom shape oecluder with the median age of （ 15.8 ± 5.6） months（ranging 8 to 36 months） and the mean weight of 7.8 - 17.5 （ 12. 0 ± 4. 3 ） kg. Pulmonary arterial pressure, aortic pressure and oxygen saturation were measured. The mean PDA diameter of narrowest segment was 1.5 - 14.3（4.3 ±3.1） mm by aortography. Lateral descending aortographies were performed to evaluate the immediate results 30 min after the procedure and follow-up evaluations were performed with color flow mapping respectively at 24 h, 1, 3, 6 months and 1 year after closure. RESULTS： The devices were successfully placed in 74（94.9% ） of the 78 cases. Complete angiographic closure was seen 30 rain after the device deployment in 52 of the 74 cases（70.3% ） while small leaks were presented in 22 cases （29. 7% ）. Complete echocardiographic closure was observed in 71 out of the 74 patients （95.9%） at 24 h and 100% at 1 month after the procedure. No PDA recanalization and migration of the devices and no complications were seen after the complete ocelusian during 1-12 months follow-up. CONCLUSION： Catheter closure of infant PDA using the mushroom shape occluder is a safe and effective interventional therapy under strict indication selection.