Rashkind双面伞治疗动脉导管未闭的远期疗效评价

Long-term efficacy of transcatheter closure of patent ductus arteriosus with the Kashkind double umbrella

目的 评价Rashkind双面伞治疗动脉导管未闭(PDA)的远期疗效。方法 1994年7月至1998年12月,对49例PDA患者施行了Rashkind双面伞封堵术。经股静脉途径置入Rashkind双面伞,封堵后10～30min行主动脉造影。术后24h、1、3、6、12个月及以后每隔6个月行超声心动图和X线胸片检查。结果 47例患者治疗成功,2例进行了外科手术。封堵后10～30min,微量、少量、中量、大量残余分流率分别为12.8％(6/47)、27.7％(13/47)、25.5％(12/47)和14.8％(7/47),完全封堵率19.2％(9/47)。近期(≤3个月)随访36例患者,3个月残余分流率为44.4％(16/36)。中期(3～36个月)随访30例患者,36个月残余分流率为13.3％(4/30)。远期(>36个月)随访25例患者,平均随访时间60±12个月(38～96个月),4例患者仍存在残余分流,其中术后46、48个月有残余分流的2例患者经置入Amplatzer封堵器后达到完全封堵。结论 Rashkind双面伞治疗PDA远期残余分流不能自然消失,需行2次封堵术。

Objective To evaluate the long-term efficacy of transcatheter patent ductus arteriosus (PDA) closure with the Rashkind double umbrella. Methods Between July 1994 and December 1998, forty nine patients (12 male, 37 female) at a mean age of (21±13) years (range 2.4 to 54 years) underwent attempted transcatheler closure of a PDA using the Rashkind double umbrella. The Rashkind double umbrella was implanted through femoral venous route. Aortography was performed to check any residual shunt presence, 10 to 30 minutes after the closure. Echocardiography and X-ray chest film were performed at 24 h, 1 , 3, 6 and 12 months after the closure, and at 6-month intervals thereafter. Results Forty seven of the 49 patients had successful device placement. Two patients underwent surgical therapy. The prevalence of trace, mild, moderate, and large residual shunt was 12. 8% (6/47) , 27. 7% (13/47), 25. 5% (12/47), and 14.8% (7/47), respectively, and the prevalence of complete closure was 19. 2% (9/47) 10 to 30 minutes after the procedure. Of the 49 patients, 36 completed short-term (≤3 months) follow-up, the prevalence of residual shunt was 44.4%(16/36) al 3 months. 30 patients completed medium-term ( >3 months and ≤36 months) follow-up, the prevalence of residual shunt was 13.3% (4/30) at 36 months. For the long-term ( > 36months) follow-up (38-96 months, mean 60±12 months) in 25 patients, there were 4 patients with residual shunt across PDA. Two patients with residual shunt at 46 and 48 months, respectively, had complete closure after reocclusion using the Amplauer duct occluder. Conclusions The long-term residual shunt after closure of PDA with the Rashkind double umbrella can not disappear spontaneously, thus a second device is sometimes needed to achieve complete closure.