目的 探讨单静脉入路超声导引封堵动脉导管未闭(PDA)的可行性.方法 自2003年5月至2010年4月共对123例PDA患者进行封堵治疗,其中采用动静脉双入路法46例,采用单静脉入路超声法77例.动静脉双入路法通过主动脉弓降部左侧位造影观察PDA的形状、最窄内径及术后分流情况,作为选择封堵器大小的依据及即时疗效评价手段.单静脉入路超声导引法通过心脏超声观察PDA的形状、最窄内径及术后分流情况,作为选择封堵器大小的依据及即时疗效评价手段.术后3 d、1个月、6个月及1年复查心脏超声.结果 118例患者采用初次选择的封堵器手术成功,4例换用更大型号的封堵器后手术成功,1例换用更小型号的封堵器手术成功,技术成功率100%.与动静脉双入路法相比,单静脉入路超声导引法简化了手术程序,缩短了透视时间及手术时间,无需使用对比剂;手术成功率与前者无差别.结论 单静脉入路超声导引封堵治疗PDA是一种较好的简化封堵方法,值得推广.%Objective To explore the feasibility and effectiveness of transcatheter closure of patent ductus arteriosus (PDA) with Amplatzer occluder by using single venous approach method under ultrasound monitoring. Methods During the period from May 2003 to April 2010. transcatheter closure of PDA were performed in 123 cases. Of the 123 patients. the procedure was accomplished by using arteriovenous dual approach method in 46 and by using single venous approach method in 77. All the procedures were monitored by ultrasound. The shape , size of PDA and immediate therapeutic results were checked with angiography in arteriovenous dual approach method or with ultrasonography in single venous approach method. The size of Amplatzer occluder was individually selected according to the smallest diameter of PDA. Echocardiography was performed at 3 days, one, 6 and 12 months after the procedure to evaluate the results. Results Successful device placement with the initially selected occluder was obtained in 118 cases. In 4 cases the procedure was eventually completed after a bigger occluder was employed to replace the initial one. while in one case a smaller occluder had to use to replace the first one. The technical success rate was 100％. Conclusion The transcatheter closure of PDA with Amplatzer occlucler under ultrasound monitoring by single venous approach methocl is clinically effective and feasible. Being technically simple and time-saving, this single venous approach method is of great value in clinical practice. (J Intervent Racliol, 2011, 20 : 682-684)
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