应用Amplatzer封堵器治疗动脉导管未闭疗效观察

目的　应用Amplatzer封堵器治疗动脉导管未闭 (patentductusarteriosus ,PDA)并评价其临床疗效。 方法　 7例患者 ,女 2例 ,男 5例 ,年龄 2 .5～ 5 6岁 ,体重 10 .0～ 73 .5kg ,均经超声心动图确诊。术中行右心导管测压后 ,进行主动脉弓降部造影 ,以确定PDA的位置、形状及最窄直径。选择大于所测PDA最窄直径 3～ 6mm的封堵器 ,于透视下经输送鞘管将其封堵于PDA处。 10分钟后重复造影 ,若封堵器形状、位置满意 ,无或仅有微～少量残余分流时 ,可释放封堵器。术后 1周 ,1～ 6个月行超声心动图、心血管摄片检查 ,观察残余分流情况、封堵器位置及心脏大小的变化。结果　主动脉弓降部造影显示PDA均呈管型 ,PDA最窄直径平均为 5 .5± 3 .1mm ( 3 .0～ 11.8mm )。均有肺动脉高压 ,其中轻度 6例 ,重度 1例。 7例封堵器均放置成功。造影示 6例即刻完全封堵 ,1例有微量残余分流 ,此患者术后 18小时发生急性溶血 ,经内科保守治疗治愈 ,术后 1个月彩色多普勒超声心动图示残余分流消失 ,随访 6个月 7例患者心脏均有不同程度缩小。结论　应用Amplatzer封堵器治疗PDA是一种方法简便 ,成功率高 ,近期疗效可靠的介入方法

Closure of the patent ductus arteriosus with the Amplatzer PDA device:Initial results

Objective To evaluate the immediate and short-term results of transcatheter closure of patent ductus arteriosus(PDA)using Amplatzer duct occluder(ADO)device.Methods Seven patients(2 females,5 males),aged 2.5-56 years,were treated by transcatheter closure with ADO.All patients were diagnosed with echocardiography.Conventional right and left catheterizations were performed under general or local anesthesia to determine pressure and evaluate the morphologic characteristics,position and minimum diameter of the ductus.The size of ADO was 3 to 6 mm larger than the narrowest diameter of PDA.Each PDA was occluded through the venous or arterial side using a long sheath to deliver the ADO.Aortography was repeated 10 minutes after the closure to assess the degree of residual shunt and confirm the device position.Once the position of the device was founded to be satisfactory and without or with only a trace to small residual shunt was confirmed ,the device,was released.and echocardiography were performed 1 week,1 to 6-month after the procedure.Results The mean angiographic PDA diameter was 5.5±3.1 mm(range 3.0-11.8 mm).All patients had pulmonary hypertension.The device was successfully placed in the PDA in all patients.Angiography showed that 6 patients had complete immediate closure and one had a trace shunt.The patient with a trace shunt developed symptomatic hemolysis 18 hours after the procedure and recovered by the treatment with internal medicine 1 week after the procedure.The trace shunt disappeared 1 month after the procedure.Echocardiography showed pulmonary pressure and heart size in all cases were improved after 1 week,1,3 and 6 months.Conclusions Transcatheter closure is a safe and effective interventional procedure in the treatment of PDA.To avoid the complication of hemolysis,we should achieve complete or nearly complete closure of the ductus and reduce any residual shunt.