应用Amplatzer房缺封堵伞堵塞成人特殊动脉导管未闭

Transcatheter occlusion of specific patent ductus arterious with Amplatzer atrial septal occluder in adults

目的:评价Amplatzer房缺封堵伞(AASO)堵塞特殊类型动脉导管未闭(PDA)的可行性及近期效果。方法:采用经导管Amplatzer AASO堵闭特殊类型巨大PDA并重度肺动脉高压5例。术后24 h、60 d、180 d进行经胸超声心动图及X线胸片、心电图复查随访。结果:5例均堵闭成功;2例术后完全无分流,2例术后残余2mm左向右分流,1例残余明显穿伞分流,分别在60 d、180d随访中分流完全消失;血流动力学和心脏解剖在术后及随访期间有显著改善。结论:Amplatzer AASO可用于堵闭形态特殊、管径较大的PDA,即时残余穿伞分流率高,近期效果好。

Objective:To evaluate the feasibility and effectiveness of transcathether closure of specific huge patent ductus arterious(PDA) with Amplatzer septal occluder. Methods: Five male patients with specific huge PDA and had severe pulmonary hypertension were occluded with Amplatzer atrial septal occluder(AASO). They were 32, 35, 21, 18 and 33 years old. 3 of them were pipe-shaped PDA (diameter is 15,16 and 20 mm) one was window- shaped PDA (diameter is 17 mm), one was cone-shaped PDA (diameter of the aortic end was 19 mm; the length was 28;diameter of the pulmonic end was 10) . Under local anesthesia, Conventional left and right heart catheterization and aortography were performed to find out the morphologic characteristics, position and minimal diameter of ductus. Then a suitable sized balloon was put to occlusion PDA and to record the change of pulmonic pressure (PAP). The PDA were occlued with AASO according to the characteristic and size of PDA under X-ray fluoroscopy. And it was followed up for 1 to 2 day and 60 days after treatment. Results:All 5 cases were occluded successfully. There was 2 mm residual shunt in 2 patients and stacked small residual shunt in one patient. During 3~6 months follow-up, all residual shunts had evanished slowly. The PAP was gravitated 35~52 mmHg. The capacity of left ventricular in the Doppler examination and C/T in the X-ray reduced obviously. Conclusion: Amplatzer atvial septal occluder may be used to occlude specific huge PDA. It had a good short term results.