年龄和未闭动脉导管大小对蘑菇伞封堵器选择的影响

Impact of age and the size of patent ductus arteriosus on the selection of occluders

目的 探讨年龄及未闭动脉导管大小对蘑菇伞封堵器尺寸选择的影响及临床意义。方法 6 2例动脉导管未闭 (PDA)的患者中 ,儿童 36例 ,年龄 (5 5± 2 7)岁 ;成人 2 6例 ,年龄 (19 7± 12 3)岁。应用X线降主动脉造影测量PDA的最小直径 (D1) ,并与最终所选择的封堵器直径 (D2 )比较 ;以彩色多普勒血流显像 (CDFI)观察残余分流情况。结果 (1)在 6 2例患者的 6 9次封堵尝试中 (更换封堵器 7例次 ) ,即刻CDFI观察到边缘性残余分流束宽度 >2mm者 8例、≤ 2mm者 2 4例 ;中央性残余分流束 15例。在 30min内 ,中央性残余分流束均可自行消失 ,≤ 2mm的边缘性残余分流束多数可自行消失 ,>2mm的边缘性残余分流束不能自行消失。 (2 )在PDA的最小直径相同时 ,儿童组所需封堵器的尺寸比成人组平均大 1 5mm。 (3)在达到满意的封堵效果时 ,儿童组D2 =1 5 7D1+0 5 7,成人组D2 =1 6 0D1- 1 0 1。结论 传统的封堵器尺寸选择标准具有局限性 ;在用蘑菇伞封堵器封堵PDA时 ,年龄和PDA的大小对封堵器尺寸的选择具有显著影响 ;达到满意的封堵效果时 ,所选择封堵器的尺寸遵循一定的线性规律。

Objective To evaluate effects of age and the size of patent ductus arteriosus (PDA) on the selection of Amplatzer occluders and its clinical significance during trans catheter closure of PDA Methods The narrowest diameters of PDA(D 1) were measured by aortography in 62 patients with PDA, among whom 36 were children and 26 adults The measurements were compared with the size of finally selected occluders (D 2) The residual stunting was assessed by colored code Doppler flow imaging (CDFI) Results In 69 occluding attempts including replacement of 7 occluders, the marginal residual shunting was detected by CDFI in 8 cases (>2 mm in width) and 24 cases (≤2 mm in width), and the central residual shunting in 15 cases Within 30 minutes, all of the central residual shunting and most of ≤2 mm marginal residual shunting automatically disappeared but >2 mm marginal residual shunting did not When D 1 was similar, D 2 in child group was 1 5 mm bigger than that in adult group When achieving satisfactory closure of PDA, the regression equation in child group was D 2=1 57D 1+0 57, in adult group D 2=1 60D 1-1 01 Conclusion During trans catheter closure of PDA, the traditional criteria for selecting the size of occluders are improper Age and PDA diameter significantly affect the selection of occluder dimension A linear relation exists between the size of the finally selected occluders and the narrowest diameter of PDA