经导管堵闭婴幼儿大型动脉导管未闭(≥4mm)的短中期随访

Transcatheter closure of large patent ductus arteriosus (≥4 mm) in infants:immediate and mid-term results

目的分析经导管封堵婴幼儿大型动脉导管未闭(patent ductus arteriosus,PDA)(≥4 mm)的短中期随访的结果。方法回顾性分析50例大型PDA患儿的疗效、并发症及中期随访结果 ,评价其中期疗效、安全性及影响疗效的因素。结果成功植入封堵器49例(98%),其中46例(92%)应用PDA封堵器,2例(4%)应用肌部室间隔缺损封堵器,1例(2%)应用膜周对称型室间隔缺损封堵器。术后3 d内复查超声心动图:4例(8%)有残余分流;封堵后左心室舒张末内径、左心房内径、左心室射血分数、肺动脉收缩压、三尖瓣反流(tricuspidregurgitation,TR)及二尖瓣反流(mitral regurgitation,MR)均较术前缩小或减轻,差异有统计学意义(P<0.05);封堵后主动脉收缩压及主动脉瓣反流(aortic regurgitation,AR)较术前增加或加重,差异有统计学意义(P<0.01)。出院后完成随访41例,随访率81.6%,中位随访时间6个月(1～57个月)。残余分流率在术后3 d、1个月、6个月分别为8%、4%、2%。术后1～6个月内左心室射血分数较术后3 d有明显改善,差异有统计学意义(P=0.000);术后1年内随访:MR较术前降低,差异有统计学意义(P=0.000);AR及TR与术前比较,差异无统计学意义(P>0.05);术后1年内11例患儿出现左肺动脉血流速度加快(1.5～2.1 m/s),其中9例随访1年以上左肺动脉血流1.5～2.0 m/s,4例随访3～5年左肺动脉血流速度1.5～2 m/s,但左肺动脉至主肺动脉压差均≤20 mm Hg(1 mm Hg=0.133 kPa)。无降主动脉狭窄。结论经导管用封堵器治疗婴幼儿大型PDA(≥4 mm)的短中期疗效确切,安全性好,但对左肺血流速度增快患者需长期随访。

Objectives To explore the immediate and mid-term results of large patent ductus arteriosus （PDA） （ ≥4 mm） in infants after the interventional occlusion. Methods We retrospectively analyzed the clinical data of 50 infants with PDA （≥4 mm）, focusing on their therapeutic results, complications and follow-up results. Results Totally 49 devices （98%） were implanted successfully, including 46 （92%） domestic ductal occluders, 2 （4%） muscular ventricular septal defect devices and 1 （2%） membrane symmetric ventricular septal defect device. Echocardiogram in 72 hours after procedure was rechecked： residual shunts were found in 4 cases （8%） ; left ventricular end-diastolic dimension （LVEDd）, left atrial diameter （LAd）, left ventricular ejection fraction （LVEF）, pulmonary artery systolic pressure （PASP）, tricuspid regurgitation （TR） and mitral regurgitation （MR） all decreased or alleviated in contrast with those before operation, the differences were statistically significant （P〈0.05）; aortic systolic pressure （ASP） and aortic regurgitation （AR） increased or aggravated comparing with those before operation, the differences were statistically significant （P〈0.01）. Follow-up was conducted in 41 patients with the follow-up rate of 81.6%. The median follow-up duration was 6 months （1-57 months）. Incidence of residual shunt reduced in different follow-up periods, namely 8%, 4% and 2% at 3 d, 1 and 6 months after device occlusion respectively. LVEF at 1-6 months after procedure significantly improved comparing with that in 3 days after procedure （P=0.000）. MR in one year after procedure significantly alleviated comparing with that before procedure （P=0.000）. AR and TR in one year after procedure remained unchanged comparing with those before procedure （P〉0.05）. Blood flow velocity measured in the left pulmonary artery increased （1.5-2.1 m/s） in 11 cases in one year after procedure, of which 1.5-2.0 m/s in 9 cases beyond one year after procedure, 1.5-2.0 m/s in 4 cases at 3-5 years after procedure. Pressure gradient between the left pulmonary artery and pulmonary trunk was less than 20 mm Hg （1 mm Hg=0.133 kPa）. No case of obstruction of the descending aorta was found. Conclusions Transcatheter closure of large patent duetus arteriosus in infants is safe and feasible, but long-term follow-up is needed for patients with increased blood flow velocity in left pulmonary artery.