第二代动脉导管未闭封堵器封堵动脉导管的临床研究

摘要

目的 评估新型动脉导管未闭封堵器(Amplatzer duct occluder Ⅱ,ADO Ⅱ)治疗各种类型动脉导管未闭(PDA)的可行性和效果.方法选择2011年2月-2011年7月间确诊为PDA且无治疗禁忌证、应用ADO Ⅱ行介入治疗者26例,根据造影、心脏超声检查和肺动脉压力选择合适的ADO Ⅱ,参考动脉导管类型、导管最狭窄处直径和主动脉端壶腹部大小分别选择顺向法和逆向法释放封堵器.释放前常规行降主动脉造影观察封堵器位置是否合适,以及有无残余分流;心脏超声观察有无左肺动脉和降主动脉狭窄.术后1 d行心脏超声检查,无异常术后第2天出院.1、3、6个月时门诊随访,随访时行心电图和心脏超声检查.结果 26例介入治疗者,男11例、女15例,平均年龄(2.99 ± 1.63)岁(0.5～6.0岁),平均体质量(14.47 ± 4.24)kg(6.5～24.0 kg),平均肺循环血流量/体循环血流量(Qp/Qs)1.73 ± 0.47(1.2～2.4),导管最狭窄直径平均(1.78 ± 0.71)mm(1.2～3.6 mm).采用顺向释放18例,逆向释放8例.2例术后超声有少量残余分流;1例出现主动脉相对狭窄,升主动脉到降主动脉压差为12 mmHg.术后24 h心脏超声检查均无残余分流,1个月和3个月随访超声均无残余分流.1例主动脉相对狭窄患儿3个月随访无明显改变.结论 ADO Ⅱ适合婴幼儿合并中、小型PDA或非漏斗型PDA的封堵治疗,操作简单、方便,并发症少.%Objective To assess the feasi bility and efficacy of Amplatzer duct occlude- II (A DO II ) to occlude different types of patent ductus arteriosus (PDA). Methods Twenty-six children, 11 males and 15 females, were diagnosed as PDA from Feb 2011 to July 2011. All of them who were treated with ADO H had an indication for iuterven tional therapy without any contraindications. The size of device was chosen according to aortographic ana echocardio-graphic results and pulmonary pressure. The device was delivered from an antegrade or retrograde approach depending on the type of PDA, the minimal diameter of PDA and the size of duct ampulla. Before detaching the device, another aor togram was performed in order to check the device position and whether there was a residual shimt, to check the absence of obstruction on the arterial or venous side through echocardiogram. Ad patients were examined by echocardiogram at 24 hours after surgery and discharged without any complications 2 days later. The patients were programmed for a cardiologic consult including an echocardiogram and electrocardiogram at 1, 3 and 6 months after discharge. Results The mean age of the patients was 2-99 + 1-63 years (range 0.5 - 6 years), and the mean weight was 14.47 + 4-24 kg (range 6.5 -24 kg). The mean Qp/Qs was 1.73 + 0-47 (range 1-2 - 2.4) , the mean PDA minimal diameter was 1-78 + 0.71 mm (range 1.2 - 3.6 mm). ADO-Ⅱ was delivered through pulmonary venous approach in 18 patients and 8 patients through aortic approach. In two patients, there was a trivial residual shunt after the surgery. One had a descending aortic obstruction with pressure gradient (from ascending to descending aorta) of 12 rnmHg. No residual shunt was found after 24 hours. There was no existence of residual shunt after 1 and 3 months in follow-up, and no obvious change in aortic obstruction. Conclusions ADO Ⅱ is a preferred alternative in treating infants or younger with moderate and small PDA or ducts with nonconical shape. It is simple in use and with few complications.