婴幼儿动脉导管未闭的急诊／亚急诊介入治疗

Emergency and sub - emergency transcatheter closure of patent ductus arteriosus in infants

目的总结婴幼儿动脉导管未闭（PDA）急诊／亚急诊介入治疗的疗效及随访结果。方法回顾性分析2008年3月至2014年4月广州市妇女儿童医疗中心12例婴幼儿PDA急诊／亚急诊介入治疗的效果、并发症及近期、中期随访结果，评价其疗效和安全性。术前均确诊支气管肺炎，10例合并充血性心力衰竭，经内科规范治疗肺部体征无明显好转。结果成功植入封堵器12例（100％）。术后3d复查超声心动图：无残余分流，左心室舒张末内径[（31．3±5．4）mm]、左心房内径[（18．2±3．4）mm]、左心室射血分数[（56．8±8．7）％]、肺动脉收缩压及二尖瓣返流均较术前缩小或减轻（P均〈0．05），主动脉收缩压较术前增加（P〈0．01）。随访10例（83％），均无残余分流。术后0．5年左心室射血分数较术后3d明显改善（P〈0．05），二尖瓣返流较术前减轻（P〈0．05），主动脉瓣返流及三尖瓣返流无明显变化（P〉0．05）。3例患儿术后出现左肺动脉血流速度加快，术后2例降主动脉血流速度1．9m／s、2．4m／s，随访23～28个月左肺动脉血流及降主动脉血流速度〈2．3m／s，压差均〈2．9kPa，不需干预治疗。结论婴幼儿PDA急诊／亚急诊介入治疗的近期．中期疗效确切，安全性好，但左肺血流速度及降主动脉血流速度增快者需长期随访。

Objective To explore the effects and follow - up findings of emergency and sub - emergency transcatheter closure of patent ductus arteriosus （PDA） in infants. Methods A retrospective study was performed to analyze the effects, complications ,immediate and mid- term follow- up outcomes in 12 infants with PDA from Guangzhou Women and Children＇s Medical Center between March 2008 and April 2014 in order to evaluate the efficacy and safety of transcatheter closure of PDA in infants. All cases were diagnosed preoperatively as pneumonia, and 10 cases had congestive heart failure. Pulmonary symptoms showed no obvious change after regular internal medicine therapies. Results Twelve devices （ 100% ） were successfully implanted. Echoeardiogram was performed 3 days after the procedures and showed no residual shunt in any case. Left ventricular end -diastolic dimension [ （31.3 ±5.4 ） mm] ,left atrial diameter [ （ 18.2 ±3.4 ） mm ], left ventricular ejection fraction （ LVEF ） [ （ 56.8 ±8.7 ） % ], pulmonary artery systolic pressure and mitral regurgitation were decreased or alleviated in contrast with those before the procedures（ all P 〈 0.05 ） , but systolic aortic pressure was increased（P 〈 0.01 ）. Follow -up was conducted in 10 cases （83%） and there was no residual shunt in any case. LVEF was improved and MR was significantly alleviated 6 months after the procedure compared with those 3 days after the procedure （ all P 〈 0.05 ）. Aortic regurgitation and tricuspid regurgitation 6 months after procedure unchanged （ P 〉 0.05 ）. Left pulmonary artery blood flow velocity was increased in 3 cases. The maximal descending aorta blood flow velocity was 1.9 m/s and 2.4 m/s respectively in 2 eases ,blood flow velocity of left pulmonary artery and descending aorta were blow 2.3 m/s,pressure gradient was less than 2.9 kPa in 23 -28 months after the procedure and no patient received any other intervention. Conclusions Emergency and sub - emergency transeatheter closure of PDA in infants is safe and feasible, but long - term follow - up is needed in patients with increased left pulmonary artery blood flow velocity and/or descending aorta blood flow velocity.