巨大动脉导管未闭的封堵治疗

Large patent ductus arteriosus（PDA） closure treatment with domestic occluder

目的 评价应用国产封堵器封堵治疗巨大动脉导管未闭（PDA）的疗效.方法 全组17例,男性8例,女性9例,年龄15～43（24.5±11.1）岁.主动脉造影示PDA最窄腰部内径为18～26（25.5±1.8）mm,需采用腰部直径20mm以上的封堵器方可操作成功.术后3d及3个月后复查超声心动图.结果 术前超声诊断,17例中6例合并重度肺动脉高压,17例患者中14例（其中5例合并重度肺动脉高压）封堵成功（操作和临床成功）,成功率为82％（14/17）.16例选用国产特制PDA封堵器,1例26 mm ASD因封堵器位置不能牢固地“站稳”而放弃封堵治疗;1例严重肺动脉高压且左向右分流为主存在少量右向左分流,经封堵试验为阻力性肺动脉高压不适宜治疗;1例术后第2天发生封堵器脱落入降主动脉,经捕获器成功取出体外,但死于误吸（迷走反射引起恶心呕吐）导致的严重肺部感染及感染性休克.封堵成功14例,封堵器直径为22～30（26.5±2.7）mm,术后即刻降主动脉造影检查示9例微量残余分流,均为封堵器中间存在云雾状分流,10 min后重复造影云雾状分流消失.术后3d及术后3个月超声心动图示患者所有左心内径增大均明显回缩,未发现残余分流和导管再通.结论 巨大PDA在可能的范围内尽量争取介入治疗,成功后较普通PDA血液动力学恢复更明显,可获得较好的收益/风险比.

Objective To evaluate the efficiency of large patent ductus arteriosus（PDA） closure treatment with domestic occluder.Methods 17 patients（8 males,9 females）,aged 15-43（24.5±11.1）years old.Aortic angiography showed the waist size of PDA 18-26 （25.5±2.7）mm,and the occluder above 20 mm was required.Echocardiography was performed postoperative 3 days and 3 months.Results In 17 cases,14 cases （of which 5 patients with severe pulmonary hypertension） were accomplished both in operation and clinical procedure,the success rate was 82％（14/17）.16 cases were operated by domestic PDA occluders.One case undergoing the 26 mm ASD occluder,which failed to ＂stand firmly＂ gave up the therapy.one case with severe pulmonary hypertension,though dominated by left-to-right shunt was confirmed as a resistance hypertension and gave up.The second day after,one case occurred occluder falling off into the descending aorta,which was removed successfully by catheter capture,but died of lung infection and septic shock induced by aspiration during vagal reflex.The occluder in 14 patients ranged 22-30 （26.5±2.7）mm,which showed a little residual shunt of 9 cases but disappeared after 10 minutes angiography.Echocardiography showed after 3 days and 3 months,left ventricular,left atrial and pulmonary systolic pressure had decreased significantly except pulmonary artery and no residual shunt or repatency.Conclusion It＇s a pressing topic to deal large PDA in a logical range with interventional closure,which would bring the speedy hemodynamic recovery than that of normal PDA and get a better benefit/risk ratio.