2代 Amplatzer 血管塞在经导管介入治疗儿童冠状动脉瘘中的应用

摘要

Objective To investigate the feasibility and safety of transcatheter closure of coronary artery fistula (CAF)with Amplatzer vascular PlugⅡ(AVPⅡ)in pediatric patients.Methods Between June 2012 and October 2015,5 children aged 0.9 to 7.0 years old and weighted 10 to 21 kg with CAF were admitted to the Department of Pediatric Cardiology in Shandong Provincial Hospital Affiliated to Shandong University.Aortic root angiography was used first to confirm the origin,shape,branches,drainage and the diameter of the orifice of CAF by deploying the pigtail catheter.The AVPⅡwas retrogradely deployed into targeted artery through guiding catheter and aortic angiography was performed before releasing the plug.Results All the 5 children underwent transcatheter closure by AVPⅡsuccessful-ly.Two cases were involved with right coronary -right ventricular fistula,1 case of left anterior descending coronary -right ventricular fistula (residual fistula after surgical repair),and 1 case of left circumflex coronary -left atrial fistula. Four children had a single fistula,and 1 case had double fistulas.The diameter of the orifice ranged from 2.00 to 5.96 mm,and the selected occluders from 8 to 14 mm.The ratio of diameter of occluder to fistula orifice ranged from 2.3 to 3.4.All the patients were followed up for 4 to 44 months.Two patients developed instant minor and modera-te aortic re-gurgitation.No other complications such as thrombosis,embolization,residual shunt,arrhythmia,coronary dissection or perforation occurred.Conclusions Transcatheter closure of CAF by AVPⅡin pediatric patients is feasible and safe. Aortic regurgitation should be noted,especially during the procedure.%目的：探讨应用2代 Amplatzer 血管塞（Amplatzer vascular PlugⅡ，AVP Ⅱ）经导管关闭先天性冠状动脉瘘的可行性与安全性。方法选择2012年6月至2015年10月在山东大学附属省立医院小儿心脏科病房收治的5例冠状动脉瘘患儿为研究对象，年龄0．9～7．0岁，体质量10～21 kg。先用猪尾导管于主动脉根部造影显示病变冠状动脉的起源、走行、分支及其引流部位，并测量瘘口直径。将指引导管循导丝送入病变血管，选择合适的 AVPⅡ，送入病变血管，冠状动脉造影显示封堵效果好便释放 AVPⅡ。结果5例患儿均成功经股动脉端逆行应用 AVPⅡ完成经导管介入封堵术，其中2例为右冠状动脉右心室瘘，1例为左冠状动脉前降支右心室瘘（外科结扎术后残余瘘），1例为左冠状动脉回旋支右心房瘘。5例中4例为单瘘口，1例为双瘘口。冠状动脉瘘口直径为2．00～5．96 mm，选用的 AVPⅡ直径为8～14 mm，封堵器与瘘口的直径之比为2．3～3．4。随访4～44个月，2例左冠状动脉瘘的患儿术后即刻出现主动脉瓣反流，分别为轻度及中度，无封堵器脱落、残余分流、心律失常、冠状动脉夹层、冠状动脉穿孔及血栓形成等其他并发症。结论应用 AVPⅡ经导管逆行封堵先天性冠状动脉瘘操作简便、安全有效，但应注意主动脉瓣反流等并发症。