特殊的动脉导管未闭的封堵术

Transcatheter closure of special patent ductus arteriosus

目的 探讨特殊的动脉导管未闭 (PDA)封堵术的方法和疗效。方法 1995年 2月至2 0 0 2年 2月应用可回收弹簧圈及Amplazer封堵器成功治疗了 32 1例各种PDA ,其中 5 1例为特殊的PDA ,分别为 :PDA合并肺动脉狭窄 (PS) 3例、合并主动脉缩窄 (COA) 3例、合并房间隔缺损 (ASD) 2例、合并主动脉瓣狭窄 (AS) 3例、合并纠正性大动脉转位 (L TGA) 1例、右位主动脉弓左位PDA合并迷走右锁骨下动脉 1例、合并中度或中度以上二尖瓣关闭不全 (MR) 38例。治疗方法为同时应用球囊扩张和其他封堵技术治疗合并畸形。术后行心脏超声及临床检查随访。结果 所有 5 1例患者介入治疗术均获得成功。PDA直径为 1 2～ 6 9mm ,平均直径为 (3 0± 1 2 )mm ,所有PDA中临床关闭 (听诊无杂音 )在出院时达 10 0 % ,超声彩色多普勒检查在出院时无分流达 10 0 %。 2例合并ASD者 ,在ASD堵塞后即刻也无残余分流。球囊扩张的AS、PS、COA随访疗效均良好。合并MR中 ,二尖瓣返流明显好转占 92 1% (35 38)。在平均 3 8年随访中没有任何并发症。结论 一些特殊的PDA或合并其它先天性心脏病组合可通过心导管介入技术来治愈。

Objective To assess the effect and methology in occlusion of special patent ductus arteriosus (PDA). Methods Transcatheter closure of special PDA with Amplatzer Duct Occluder and Duct Occluder was performed in 51 patients, of whom 3 had pulmonary stenosis(PS), 3 coarctation of aorta (COA), 2 atrial septal defect (ASD), 3 aortic stenosis (AS), 1 right aortic arch and 1 corrected transposition of the great arteries, and 38 moderate to severe mitral regurgitation (MR). They were all performed with balloon dilation. ASD was treated with other closure devices simultaneously. Results The device was successfully implanted in the 51 patients. The mean minimum diameter of the PDA was (3.0±1.2) mm (ranging from 1.2 to 6.9 mm). The clinical closure rate and the echocardiographic complete closure rate were both 100% at discharge. Device placement was successful and complete occlusion occurred immediately in 2 cases with ASD. Balloon dilation was successful too. The results showed that 35 of 38 (92.1%) cases in PDA with MR got better outcome. At a median follow-up interval of 3.8 years there were no complications. Conclusion It is suggested that PDA occluder devices are safe for the catheter closure of the special PDA.