胸骨下小切口经心尖封堵小儿动脉导管未闭

Transcatheter Closure of Patent Ductus Arteriosus in Children Through the Apex of the Heart

目的探讨胸骨下小切口经心尖封堵动脉导管未闭(patent ductus arteriosus,PDA)的疗效。方法回顾性分析2016年7月～2017年5月11例胸骨下小切口经心尖PDA封堵术资料。年龄6. 6～32(17. 0±8. 7)月,体重7. 5～14(9. 4±2. 0) kg,PDA直径3～7(4. 2±1. 2) mm。选择胸骨下剑突区纵向切口1～2 cm,部分暴露右心室表面后,在经食道超声心动图(transesophageal echocardiography,TEE)引导下,血管鞘穿刺右心尖,沿右心室-肺动脉-PDA路径置入PDA封堵器,TEE评估封堵效果。结果术中TEE即刻测量封堵器位置良好,无明显残余分流,11例手术均取得成功。1例术后一过性血小板减少。随访18～28(23. 2±3. 8)月,超声心动显示无残余分流,未见心脏磨蚀,心电图显示无心律失常,心肺功能及生长发育正常。结论胸骨下小切口经心尖封堵PDA具有安全、有效、操作简单等特点,不需锯开胸骨,避免损伤乳腺组织。

Objective To evaluate the clinical efficacy and safety of substernal mini-incision transcatheter occlusion of patent ductus arteriosus(PDA).Methods We retrospectively analyzed 11 children who received transthoracic minimally invasive occlusion in our hospital from July 2016 to May 2017.These 11 children were aged 6.6-32(17.0±8.7)months old and their body weight ranged 7.5-14(9.4±2.0)kg.The PDA sized 3-7(4.2±1.2)mm.The inferior sternum was selected as incisional position.After partial exposure of the right ventricular surface,the right ventricular apical was punctured by vascular sheath under the guidance of transesophageal echocardiography(TEE).Then a PDA occlude was implanted via the right ventricle-pulmonary artery-PDA.The effect was evaluated by TEE.Results The occlusion results evaluated by TEE showed that all the 11 cases were successfully operated with good position of occluders and no obvious residual shunt.Transient thrombocytopenia occurred after operation in 1 patient and recovered after treatment.During 18-28(23.2±3.8)months of follow-ups,no residual shunt or cardiac abrasion was observed.The electrocardiogram showed no arrhythmia.Cardiopulmonary functions were normal and the children’s growth was normal.Conclusions Transcatheter occlusion of PDA through a small substernal incision is safe and simple.It is a good choice for PDA in children without sternotomy and avoiding damage to breast tissue.