超声心动图在动脉导管未闭介入治疗中的应用

Application of Echocardiography in Interventional Therapy of Patent Ductus Arteriosus

目的探讨超声心动图在Amplatzer堵闭器介入治疗动脉导管未闭(PDA)中的应用。方法堵闭术前超声观察PDA形态,测量其最小内径、肺动脉内径、左心腔、左室收缩功能指标。术后超声检测堵闭器位置、有无残余分流、肺动脉及降主动脉是否梗阻狭窄及肺动脉、左心腔等大小。结果与主动脉弓部左侧位造影比较,术前超声检测PDA形态、最小内径测量值等差异无统计学意义(P>0.05)。15例患者中13例堵闭成功,术后即刻超声检查,10例无分流,3例少量分流。堵闭器位置均正常,降主动脉、肺动脉未见梗阻变窄,左心及肺动脉均较术前缩小。结论超声心动图在PDA堵闭术前病例选择、判断PDA大小形态、选择合适型号的堵闭器及术后疗效评价等方面具有重要的作用。

Objective To discuss the application of echocardiography in interventional therapy of patent ductus arteriosus（PDA） using Amplatzer occlusion device. Methods Observing the shape of PDA, measuring the minimal diameter of PDA, the diameter of pulmonary artery, the size of left atrium and left ventricle and the index for systolic function of the left ventricle by echocardiography before occlusion. Echocardiography was performed immediately, one week later and one to six months later after closuring in order to observe the position of the occlusion device, determine whether there was residual shunt, detect whether the pulmonary artery and descending artery were obstructed, estimate the change of the size and the systolic function of the heart Results 9 were of filler type and 6 were of duct type in 15 patients detected by echocardiography, the minimal diameters of PDA were 2.4mm to 9.2mm,mean 42mm.8 were of filler type and 7 were of duct type in 15 cases showed by left-side aortography,the minimal diameters were 2.0mm to 11.0mm, mean 4.6mm. No obvious difference was showed between the two methods for the observation of the shape and measurement of PDA （/~0.05）. The device was placed successfully in 13 patients, echocardiography was performed immediately after closuring, color doppler flow imaging （CDFI） revealed complete closure in 10 patients, trivial residual shunt through the occlusion device in 2 patients and they had complete elimination of the residual shunt flow one week later, trivial residual shunt passed by the occlusion device in 1 patient and he had complete elimination of the residual shunt flow one month later. Echocardiography showed the positions of the occlusion device were normal, descending artery and pulmonary artery were not obstructed, the sizes of left atrium and left ventricle and the diameters of pulmonary artery were decreased significantly in all 13 patients. Conclusion Echocardiography is valuable to select patient before interventional treatment, to observe the shape and diameter of PDA, to choose appropriate type of occlusion device and to assess the effect of treatment, etc.