第Ⅱ代动脉导管未闭封堵器栓塞幼儿体肺侧支的临床应用

Clinical study application of Amplatzer duct occluder Ⅱ to occlude aortopulmonary collateral arteries

目的探讨Amplatzer第Ⅱ代动脉导管未闭封堵器（amplatzer duct occluderⅡ,ADOⅡ）栓塞幼儿体肺侧支的可行性及效果。方法入选2014年3月3日至2015年4月1日7例患儿（其中男6例,女1例）选用ADOⅡ栓塞体肺侧支,栓塞后行选择性体肺侧支造影,观察封堵器的位置、形态及封堵效果。结果 7例介入栓塞患儿,年龄5~71个月,体质量4.2~22.0 kg。有6例患儿栓塞成功,1例栓塞后出现严重低氧血症放弃介入治疗,择期行外科体肺侧支结扎术。介入栓塞15支体肺侧支,共用ADOⅡ7枚、COOK公司不可控弹簧圈22枚和波科公司可控微弹簧圈2枚。即刻造影示无残余分流2例,少量残余分流4例,少-中量残余分流1例。6例介入成功患儿立即行外科术,其中5例行肺动脉闭锁根治术,1例行体肺分流术。外科术中回血不多、未见死亡,随访未见溶血及外周血管损伤等并发症发生。结论 ADOⅡ可控性高、输送鞘小、对血管损伤小,应用于幼儿合并较粗大、迂曲体肺侧支的介入治疗是安全可行的。

Objective To assess the feasibility and efficacy of Amplatzer duct occluder Ⅱ（ ADOⅡ） in occlusion of aortopulmonary collateral arteries. Methods Seven patients,6 males and 1 female,with aortopulmonary collateral circulation diagnosed previously by cardiac Computed Tomograpy or cardioangiography from Mar 2014 to Apr 2015 were enrolled. All of them were treated with ADO Ⅱ. Results The age of the patients ranged between 5- 71 months old and weight 4. 2- 22. 0 kg. Successful hybrid approach was achieved in 6 of 7 patients. One patient failed the occlusion because of severe hypoxemia and mild-moderate residual shunt after catheter intervention. Total 15 aortopulmonary collateral vessels were embolized by 7 ADO-Ⅱ,22 non-detachable coils（ Cook corp.） and 2 detachable micro-coils（ Boston Scientific corp.）. Complete embolization was achieved in 2 patients,4 patients had mild residual shunt and 1patient had mild-moderate residual shunt after the embolisation. No interventional complications recorded.Conclusions ADO Ⅱ has high controllability and suitable for application through small delivery catheter for minimally-invasive procedures to the vessels. It is a preferable alternative in treating pediatric patients with large and tortuous aortopulmonary collateral arteries.