Amplatzer封堵器经导管治疗动脉导管未闭169例的随访结果

Transcatheter closure of patent ductus arteriosus using Amplatzer occluder 1～12 months follow-up

目的 :应用 Amplatzer封堵器经导管治疗动脉导管未闭 (PDA)术后随访。方法 :全组 16 9例。PDA最窄处直径为 4 .7± 3.8(2 .0～ 13.0 ) mm。封堵后 10 min行降主动脉造影 ,术后 2 4 h及 1,3,6月 ,1年行超声心动图检查随访。结果 :16 6例 PDA采用 Amplatzer PDA封堵器治疗 ,3例采用 Am platzer房间隔缺损封堵器治疗。 1例 PDA术中证实伴有阻力性肺动脉高压未行介入治疗。术后 10 m in降主动脉造影示 ,5 4例存在微～少量残余分流 ,114例封堵完全无残余分流。术后 2 4 h13例存在微～少量残余分流 ,余超声心动图未见残余分流及再通。 1例封堵术后 10h并发溶血 ,4 8h后行外科 PDA缝合术。术后 1月超声心动图检查 5例存在少量残余分流 ,术后 3月 4例存在少量残余分流 ,6月及 1年 3例存在少量残余分流 ,最后行 PFM弹簧圈治疗未再见残余分流。无并发症发生。结论 :应用 Am platzer封堵器治疗

AIM: 1~12 months follow up were carried out to asses the safety and efficiency of the Amplatzer occluder in the transcatheter occlusion of patent ductus arteriosus (PDA) . METHODS: 169 patients with PDA underwent attempted transcatheter closure of a PDA using the Amplatzer occluder device. The mean PDA diameter at its narrowest segment was 4.7±3.8 mm (rang 2.0 to 13.0 mm). Occlusion was achieved via the antegrade venous approach. The lateral descending aortographies were performed to evaluate the immediate results 10 minutes after the procedure. Follow up evaluations were performed with 2D echocardiogram,color flow mapping and Doppler measurement of the descending aorta and left pulmonary artery velocity at 24 h and 1,3,6 and 12 months after implantation. RESULTS: 166 patients with PDA underwent attempted transcatheter closure of a PDA with the Amplatzer PDA occluder device , 3 cases with the Amplatzer atrial septal defect occluder device. One case confirmed with resistant pulmonary hypertension during the procedure was not recommended for transcatheter closure of a PDA. Complete angiographic closure was seen in 114 of 169 patients(67.5%),the remaining 54 patients had a trival to small angiographic shunt through the Amplatzer device. At 24 h,color flow mapping revealed no shunt and recanaliztion in 155 patients(91.7%),a trace to small residual shunt in 13(7 7%). One case developed haemolysis 10 h after the procedure and surgical closure of the ductus arteriosus was subsequently performed 48 h after the procedure. Color flow mapping revealed small residual shunt in 5 cases at 1 month follow up,4 cases at 3 months follow up. 3 cases were still found to have small shunt and were all successfully closured by PFM coil. No obstruction of the descending aorta or the pulmonary artery branches was noted on 1~12 months Doppler follow up studies.Neither thromboembolization nor device move or failure was encounted during the 1~12 months follow up. CONCLUSION: Transcatheter closure using the Amplatzer occluder device is a safe and effective interventional therapy for the majority of patients with patency of the arterial duct.