应用室间隔缺损封堵器治疗婴幼儿特殊形状动脉导管未闭疗效观察

Effect of ventricular septal defect occluder in the treatment of peculiar shaped patent ductus arteriosus in infants

目的评价室间隔缺损(VSD)封堵器治疗婴幼儿特殊形状动脉导管未闭(PDA)的临床疗效。方法分析2017年7月至2018年7月经主动脉弓降部造影提示窗型PDA或动脉导管长度>7 mm管型PDA,并选择VSD封堵器进行介入治疗的27例患儿的临床资料。结果27例患儿中窗型PDA 12例,男7例、女5例,中位年龄8.7个月(6个月~3岁);管型PDA 15例,男6例、女9例,中位年龄18个月(11个月~5岁)。窗型PDA选择膜部VSD封堵器,管型PDA选择肌部VSD封堵器封堵;按照窗型PDA肺动脉端内径加3~6 mm、管型PDA肺动脉端内径加2~4 mm选择封堵器腰部大小。所有患儿均成功封堵,术后均无残余分流。术后24小时、1个月、3个月、6个月、12个月复查胸片提示封堵器位置良好。术后24小时、1个月、3个月、6个月、12个月降主动脉流速均较术前明显降低,差异有统计学意义(P<0.05);术后左肺动脉流速较术前无变化,差异无统计学意义(P>0.05)。结论使用VSD封堵器介入治疗特殊形状PDA是一种有效可行的治疗方法。

Objectives To explore the clinical efficacy of ventricular septal defect(VSD)occluder in the treatment of peculiar shaped patent ductus arteriosus(PDA)in infants.Methods The clinical data in 27 children with window-type PDA or tubular-type PDA(arterial catheter length>7 mm)diagnosed by aortic arch angiography and having interventional treatment of VSD occluder from July 2017 to July 2018 were analyzed.Results There were 12 window-type PDA patients(7 boys and 5 girls)with a median age of 8.7 months(6 months to 3 years),and 15 tubular-type PDA patients(6 boys and 9 girls)with a median age of 18 months(11 months to 5 years).The window-type PDA was occluded with membranous ventricular septal defect occluder,and the tubular-type PDA was occluded by muscular ventricular septal defect occluder.The waist size of occluder was selected according to the pulmonary artery end diameter plus 3~6 mm for window-type PDA and plus 2~4 mm for tubular-type PDA.All children were successfully occluded,and there was no residual shunt after operation.Chest X-ray examination at 24 hours,1 month,3 months,6 months and 12 months after operation showed that the occluder were in good position.The descending aorta blood flow rate at 24 hours,1 month,3 months,6 months and 12 months after operation was significantly lower than that before operation,and the difference was statistically significant(P<0.05).Compared with preoperative data,postoperative left pulmonary artery flow velocity did not change,and the difference was not statistically significant(P>0.05).Conclusion VSD occluder is an effective and feasible method for interventional treatment of special shaped PDA.