成人复杂动脉导管未闭介入治疗的有效性和安全性

Feasibility and safety of transcatheter intervention ofcomplex patent ductus arteriosus in adults

目的:评价经导管介入治疗对成人复杂动脉导管未闭(PDA)患者的有效性与安全性。方法:回顾2004-04-2008-04期间在北京安贞医院接受经导管介入治疗的成人复杂PDA患者112例,最小直径<3.0mm者选用弹簧栓子,最小直径≥3.0mm者选用Amplatzer或国产蘑菇伞形动脉导管封堵器;不能常规建立输送轨道的患者采用逆行建轨方法,在常规操作的基础上,复杂PDA介入治疗遵循各自的特殊性;介入治疗成功的患者分别于术后第1周及第1、3、6和12个月行彩色多普勒超声心动图检查随访。结果:总体成功率达93.8%,术后1年残余分流的发生率为1.8%,均为少量分流,无需特殊处理,肺动脉收缩压介入治疗后[(58±20)mmHg,1mmHg=0.133kPa]较介入治疗前[(94±21)mmHg]显著下降约35mmHg(P<0.001);无一例发生死亡、再通、封堵器脱位及介入相关的肺动脉或主动脉狭窄等严重并发症,发生溶血及穿刺部位血管并发症的患者经保守治疗后均康复出院。结论:对于并发有解剖学或血流动力学异常的成人复杂PDA患者,经导管介入治疗是一种安全、有效的治疗手段。

Objective：To evaluate the feasibility and safety of transcatheter intervention of complex patent ductus arteriosus（PDA） in adults. Method：From Apr 2004 to Apr 2008,112 adult patients with complex PDA underwent transcatheter intervention in Beijing Anzhen Hospital.Coils were used for patients with small PDA（minimal ductal diameter 3.0 mm）,and Amplatzer duct occluders or China-made mushroom shape occluders were used for patients with moderate-to-large PDA（minimal ductal diameter ≥3.0 mm）.If the conventional technique could not establish the delivery railway,retrograde technique was alternative.In addition to common practice,all kinds of special tricks were used for complex PDA patients.Follow-up with color Doppler ultrasound were given at 1 week,1,3,6 and 12 months after successful interventions. Result：The total sucessful rate was 93.8%,and the rate of residual shunts was 1.8% at the end of 12 months follow-up.All the residual shunts were minimal and no special treatment were needed.The peak systolic pulmonary pressures decreased by 35 mmHg（1 mmHg=0.133 kPa） significantly [（94±21） vs（58±20）mmHg,P〈0.001].No procedure-related severe complications （including deaths,recanalization,dislocation of occluders,stenosis of aorta or pulmonary artery） occurred.Somepatients developed hemolysis or arterial complications,and all were cured by conservative therapy. Conclusion：Transcatheter intervention is an effective and safe treatment for adults PDA patients with complex anatomic or hemodynamic conditions.