Amplatzer血管塞经导管封堵儿童冠状动脉瘘的临床疗效(附7例报告)

Transcatheter closure of coronary artery fistulae by using Amplatzer vascular plug in children: a clinical observation and follow-up study in 7 cases

目的：探讨儿童冠状动脉瘘（CAF）使用 Amplatzer 血管塞（AVP）经导管介入封堵治疗的近中期疗效及并发症发生情况。方法收集使用 AVPⅠ、AVPⅡ经导管 CAF 介入封堵治疗7例患儿术前造影、手术治疗及术后随访资料，分析其临床疗效、术后并发症与封堵方式及抗凝方案的关系。结果7例患儿均成功封堵，使用 AVPⅠ封堵1例，使用 AVPⅡ封堵6例。术后即刻无残余分流率71．4％。术后随访4～36个月，患儿心胸比例、受累冠脉起始段直径减小，与术前比较差异有统计学意义（P 均＜0．05）。术后左室射血分数均在正常范围内。术后行口服阿司匹林抗凝6例，无抗凝、抗血小板治疗1例。出现封堵器移位伴明显残余分流1例，停用抗凝药后残余分流逐渐减少；1例用 AVPⅠ出现明显残余分流，停用抗凝药后无改善，予弹簧圈封堵后残余分流减少。7例均无血栓事件发生。结论使用 AVPⅠ、AVPⅡ封堵儿童 CAF 可减少分流量，改善患者症状；术后常见并发症是残余分流和封堵器移位；配合抗凝或抗血小板治疗时需参考残余分流情况。

Objective To investigate the early and medium-term effect of transcatheter closure （TCC）of congenital coronary artery fistulae （CAF）by using Amplatzer vascular plug （AVP）in children and the occurrence of postoperative complications.Methods Preoperative,imaging,and postoperative follow-up data were collected from 7 patients treated with transcatheter closure of CAFs using AVPⅠ or AVPⅡ,and then we analyzed the relationships between the clinical effi-cacy,postoperative complications and closure way,anticoagulation.Results Seven cases all underwent successful TCC with 1 case of AVPI and 6 cases of AVP Ⅱ.A no-residual-shunt rate was 71.4% （5 /7）right after deploying devices.The period of postoperative follow-up was 4-36 months.Postoperative C /T ratio and diameter of right ventricle were less than the baseline levels （all P 〈0.05）.All EF% was in normal range postoperatively.Of 7 cases,3 took aspirin for 6 months after TCC,2 for 3 months,1 for 3 days,and 1 did not take any.In 1 case a move of the device was noticed with a prominent re-sidual shunt,which reduced gradually after discontinuance of aspirin therapy.In another case a prominent residual shunt was found but no improvement after discontinuance of medication,resulting in another TCC by coils.In all cases no throm-botic or embolic event was found.Conclusions TCC by AVPⅠ /AVPⅡ in children can reduced shunting and relieve symptoms.Residual shunt and migration of device may be its common complications.We should consider the residual shunt in postoperative anticoagulating or antiplatelet therapy.