单纯超声引导下经股动脉封堵动脉导管未闭的临床研究

Clinical study of transcervical occlusion of patent ductus arteriosus via femoral artery guided by ultrasound

目的探讨在经胸超声心动图(TTE)引导下应用室缺肌部伞经股动脉封堵动脉导管末闭(PDA)的有效性和安全性。方法选择2016年2月至2017年12月本院收治的单纯PDA患者53例,其中漏斗型30例,管型23例。所有患者均经TTE引导下经股动脉行PDA封堵,通过建立股动脉-动脉导管-肺动脉-右室的轨道,在TTE引导下由股动脉入路置入合适的室缺肌部伞,封堵后以TTE检查评价治疗效果,术后1、3、6个月门诊复诊。结果 53例患者均在TTE引导下成功完成PDA封堵,其中1例成人PDA,因图像质量导致超声对导管内径的诊断有误,导致多次更换封堵器,但最终封堵成功。手术操作时间(30±10)min,选用室缺肌部封堵器,封堵器腰径(12±6)mm,术后杂音消失,超声示主、肺动脉间无分流,术后住院时间3～4 d。随访1、3、6个月均无分流信号。左房前后径(LAD)[(25.8±6.1)mm vs(30.6±8.4)mm]及左室舒张末径(LVEDD)[(38.5±9.1)mm vs(45.2±11.5)mm]明显缩小(P<0.05)。结论 TTE引导下由股动脉入路应用室缺肌部伞封堵PDA是一种安全和有效的治疗方法 ,避免了X线及造影剂的损害,临床应用前景较好。

Objective To evaluate the efficacy and safety of transthoracic ecbocardiography （TTE） guided by transeatheter closure of patent ductus arteriosus （PDA） through the femoral artery. Methods From February 2016 to December 2017, 53 patients with simple PDA were selected, the funnel type in 30 cases, cast type in 23 cases. All patients were guided by TTE and transcatheter closure of PDA through the femoral artery. The femoral artery was guided by TTE by establishing the orbit of the femoral artery -catheter-pulmonary artery to the right ventricle . The fight ventficular septal defect was placed under the femoral artery approach, and the therapeutic effect was evaluated by echocardiography after occlusion. The outpatient visits were made at 1, 3, and 6 months after operation. Results PDA closure was successfully completed under TTE guidance in 53 patients. In one adult PDA, the ultrasonic diagnosis of the inner diameter of the catheter was incorrect due to the image quality, which resulted in the replacement of the occluded device several times, but the occlusion was successful. The operative time was （30 ±10）min. And the back diameter of the transcatheter closure device was （ 12 ±6 ）mm and the murmur of the transmission sheath disappeared. There was no shunt between the main pulmonary artery and the main pulmonary artery, and the length of hospitalization was 3 -4 days, No shunt signal was found at 1,3 and 6 months follow-up. Left atrial diameter （LAI）） [ （ 25.8 ±6. 1 ）mm vs （ 30. 6 ±8.4 ） mm ] and lefl ventricular end diastolic diameter （LVEDD） [ （38. 5± 9. 1 ）mm vs （45.2 ±11.5 ）mm ], were decreased significantly （ P 〈 0. 05 ）. Conclusions It is safe and effective to block PDA by using femural artery approach under the guidance of TTE, which avoids the damage of X-ray and contrast agent, and its prospect of clinical application is promising.