婴儿期动脉导管未闭介入治疗效果及随访情况

目的评价在婴儿期应用Amplatzer封堵器治疗动脉导管未闭（PDA）的临床效果。方法婴儿期PDA患儿37例应用Amplatzer封堵器行动脉导管封堵术。年龄（8.7±3.3）个月;体质量（8.6±3.5）kg。主动脉侧位造影确定动脉导管的形态和导管最窄处直径,选择封堵器。经静脉途径置入封堵器。术后24 h,1、6、12个月行胸片和超声心动图随访。结果血管造影测定导管最窄处直径（3.3±1.5）mm。术后即刻完全封堵19例（54.29%）,术后24 h超声心动图检查完全封堵者为31例（88.57%）,术后1个月超声心动图检查完全封堵者34例（97.14%）,术后6和12个月超声心动图检查示封堵成功的患儿均无残余分流。手术时间（57±43）min,X线透视时间（23.0±14.9）min。结论Amplatzer导管封堵器治疗婴儿期PDA是一种安全有效的方法,但应注意该年龄组患儿解剖学特点,防止并发症的发生。     

动脉导管未闭介入封堵术后血小板减少3例报告

应用Amplatzer法介入治疗动脉导管未闭(patent ductusarteriosus,PDA)已十余年,血小板减少是PDA介入封堵术后罕见并发症。2008年10月—2009年12月我院有3例患儿经Amplatzer法行PDA介入封堵术后出现血小板减少,现报告如下。     

儿童大型动脉导管未闭介入封堵术治疗的临床效果

目的：探讨Amplatzer法介入治疗大型动脉导管未闭(PDA)的临床效果。方法：227例大型PDA患儿,其中合并肺动脉高压者63例,应用Amplatzer封堵器行动脉导管封堵术,年龄中位数为3.2岁,体重中位数为10.6 kg,PDA最窄处直径中位数5.7 mm。结果：227例患儿中,216例封堵成功（95.2％）。合并肺动脉高压者治疗前肺动脉平均压为45±19 mm Hg,封堵术后降为22±12 mm Hg（P<0.05）。216例封堵成功患儿中,术后造影显示即刻完全封堵109例（50.5％）,术后24 h超声心动图检查完全封堵者181例（83.8％）。术后6个月和12个月超声心动图检查示封堵成功的患儿均无残余分流。结论：Amplatzer法介入封堵治疗儿童大型PDA是一种安全有效的方法。     

第二代动脉导管未闭封堵器治疗动脉导管未闭合并下腔静脉中断1例报告

目前,经导管介入封堵治疗动脉导管未闭（PDA）技术已在国内外临床广泛开展,取得了很好的疗效。常规方法封堵PDA需要建立股静脉-下腔静脉-右心房-右心室-肺动脉-PDA-降主动脉的轨道。然而,对于PDA合并下腔静脉中断的患儿,无法通过以上途径完成手术,需要选择其他途径如经颈内静脉建立轨道进行封堵。但儿童经颈内静脉途径外鞘输送困难,成功率不高。本院选用第二代动脉导管未闭封堵器（ADO-II）成功封堵1例PDA合并下腔静脉中断患儿,效果良好,现报告如下。     

儿童动脉导管未闭治疗进展

动脉导管未闭是儿童常见先天性心脏病,及时有效治疗可防止肺炎、心力衰竭、感染性心内膜炎、肺动脉高压等并发症的发生.治疗方法包括药物治疗、经导管介入治疗和手术治疗.目前绝大部分动脉导管未闭通过介入封堵可获治愈.     

婴儿动脉导管未闭合并中重度肺动脉高压介入封堵治疗临床分析

目的：分析动脉导管未闭合并中重度肺动脉高压（ pulmonary arterial hypertension, PAH）患儿介入封堵手术资料,评价其有效性和安全性。方法2011年1月至2014年12月收治的动脉导管未闭合并中重度PAH婴儿23例,在完善相关术前检查后于静脉麻醉下行介入封堵治疗,术中行右室造影及肺动脉主干测压,再行降主动脉侧位造影观察动脉导管型态大小及升主动脉、降主动脉测压,分别记录压力数值,抽取升主动脉、肺动脉及下腔静脉血各1 ml行血气分析,计算肺血管阻力,术中试封堵有效后可释放封堵器。术后24 h和1、3个月随访心脏彩色多普勒超声、胸部正位片、心电图检查。结果术后患儿临床症状消失,均痊愈出院,短期随访未出现介入治疗的相关并发症。分别对封堵术前及术后压力变化进行组内比较,主肺动脉压降低[术前（68.3±17.5）／（21.4±3.7） mmHg,术后（52.4±8.7）／（15.6±3.5） mmHg,1 mmHg ＝0.133 kPa],升主动脉压升高[术前（83.5±5.9）／（51.3±3.6） mmHg,术后（88.2±5.1）／（52.4±2.7） mmHg],降主动脉压升高[术前（81.4±3.3）／（48.2±2.7） mmHg,术后（86.5±4.7）／（51.5±3.2） mmHg],封堵术前后组内压力比较差异均有统计学意义（ t＝5.455／3.945, P＜0.01;t＝－2.696／－1.193,P＜0.05;t＝－4.167／－3.745,P＜0.01）。结论动脉导管未闭合并中重度PAH婴儿在掌握合适的手术时机及加强围术期管理的条件下,开展介入封堵是安全有效的。     

蘑菇伞封堵器介入治疗婴幼儿动脉导管未闭的临床研究

目的 评价3岁以内婴幼儿动脉导管未闭应用蘑菇伞封堵器介入治疗的临床效果.方法 全组21例,年龄9个月～3岁,平均(2.2±0.8)岁,体重6.0～13.2 kg,平均(12.6±2.5)kg.主动脉侧位造影确定动脉导管的形态和导管最窄处直径,选择合适封堵器.经静脉途径置入封堵器.术后24 h、1个月、3个月、1年、2年及3年复查胸部X线平片及超声心动图和心电图观察封堵器的位置、残余分流情况、肺动脉压及心脏大小.结果 21例患儿植入封堵器均获成功,技术成功率为100%.造影测定PDA最窄处直径2.5～10.9(5.8±2.6)mm.应用直径4～18 mm大小的PDA封堵器进行封堵.随访无严重并发症.结论 应用蘑菇伞封堵器治疗婴幼儿期动脉导管未闭具有操作简便、安全有效、技术成功率高及封堵效果好等优点.     

儿童经皮动脉导管介入封堵术后血小板快速减少的临床分析

目的探讨经皮动脉导管介入封堵术后血小板快速减少的临床特点、发病机制和防治措施。方法选择2017年1月至2018年12月青岛市妇女儿童医院心脏中心共实施经皮动脉导管介入封堵手术121例,其中6例术后发生血小板快速减少,回顾分析其相关临床资料,总结血小板快速减少发生的危险因素、临床特点、可能机制和防治措施。结果6例患儿血小板减少发生时间为术后第3-5天,血小板下降最低值为19×109/L,血小板恢复时间为术后7~20 d。造影测量动脉导管内径为4.0~4.5 mm,4例选用美国AGA公司生产规格9-PDA-0810堵闭器,2例选用上海形状记忆公司生产规格0810PDA堵闭器。骨髓学检查提示3例患儿骨髓产板型巨核细胞减少,免疫治疗后恢复良好。所有患儿血小板计数在出院时恢复正常。出院随访6~14个月,所有患儿血小板计数维持正常。结论经皮动脉导管介入封堵术后需警惕血小板快速减少,多无严重并发症发生,预后良好,免疫机制可能参与其中,需进一步研究。     

儿童动脉导管未闭介入治疗单中心疗效及中长期随访观察

目的探讨儿童动脉导管未闭(PDA)介入治疗并发症的发生及原因。方法收集2004年1月1日至2019年1月1日行介入封堵治疗PDA患儿的临床资料,比较其封堵前后及随访1年的变化。结果共收集1 408例患儿,男482例、女926例,中位月龄27.0(2.0～215.0)月,介入成功封堵1 404例(99.72%)。PDA内径术前超声测值为3.3(0.1～18)mm,主动脉造影为2.2(0.1～18)mm;选用封堵器大小为(8.47±2.52)mm。术后24小时心脏超声复查有残余分流125例,血小板减少21例,心律失常31例,溶血2例,动脉血栓3例,假性动脉瘤4例,右髂总动脉破裂1例,右肾挫裂伤1例,封堵器移位4例,降主动脉狭窄1例,肺动脉狭窄1例,三尖瓣前瓣腱索断裂1例。多元logistic回归分析显示,女性、肺动脉高压严重程度递增、封堵器直径增大为术后发生残余分流的独立危险因素(P0.05)。结论儿童PDA介入治疗安全、有效;PDA内径较大、合并中重度肺动脉高压患儿术后并发症发生率较高。     

动脉导管未闭患儿超声心动图与血管造影的对比研究

超声心动图作为一种非创伤检查方法 ,对大多数动脉导管未闭 (PDA)均可得以诊断 ,随先天性心脏病经导管介入治疗的广泛开展 ,介入手术前行超声心动图和血管造影 ,以了解PDA详细解剖结构及合并症情况亦日益显得重要[1～ 3 ] 。现将我院 1990年 1月～ 2 0 0 1年 8月诊治并具有完整超声心动图和血管造影资料 30例PDA例患儿资料进行分析 ,报告如下。对象与方法一、一般资料　 1990年 1月～ 2 0 0 1年 8月住院行介入治疗的PDA患儿 30例 ,男 8例 ,女 2 2例 ;年龄 2～ 14岁 ;体重 12～ 4 5kg。所有患儿胸骨左缘第 2、3肋间均可闻及双期或连续性…     

Transcatheter closure of secundum atrial septal defects, a ventricular septal defect, and a patent arterial duct

We report our clinical experience with the newly developed Amplatzer device in transcatheter closure of nine atrial septal defects (ASDs), one ventricular septal defect (VSD), and one patent arterial duct (PDA). Eleven patients with ASD (age range 2.5-18 years) selected according to the location and size of the defect by transesophageal echocardiography (TEE), a five-year-old patient with muscular VSD and a one-year-old patient with PDA were considered for transcatheter closure with Amplatzer devices. All procedures were performed under general anesthesia with fluoroscopic and TEE guidance, following a routine hemodynamic evaluation in the catheter laboratory. The optimal device size was selected after the balloon sizing of the ASDs. The sizes of the VSD and PDA were measured on TEE and angiography. The patients were discharged at 24 hours, after an evaluation with x-ray, electrocardiogram (ECG), and echocardiography; they were on 3-5 mg/kg/day aspirin and infective endocarditis prophylaxis for six months after the procedure. They were reassessed at six to eight weeks and Holter monitoring was done in addition. Devices were used for nine ASD patients, and for the VSD and the PDA patients. Mean ASD size was 14.3 +/- 5.3 mm at TEE and 18.3 +/- 4.3 mm at balloon sizing (p=0.02). The mean size of the device was 18.7 +/- 4.2 mm. The procedure time and the fluoroscopy time were 46.1 +/- 12.3 and 12.9 +/- 1.6 minutes, respectively. Immediately after the procedure, four patients (44%) had trivial shunts (TS). TS remained in only two during discharge, and no shunt was observed at second evaluation. The devices were similarly applied to VSD (12-7 mm) and PDA (8-6 mm) patients. Both cases had TS immediately, which disappeared at 24 hours. None of the patients had major complications. Junctional rhythm developed in one patient, and another patient had frequent supraventricular extrasystoles. Amplatzer is an effective and safe device for transcatheter closure of ASD, VSD, or PDA, especially in pediatric patients.     

经导管同期介入治疗儿童复合型先天性心脏病8例分析及随访

目的：儿童先天性心脏病(congenital heart disease,CHD)复合畸形(复合型CHD)既往外科手术是唯一的治疗方法,随着介入治疗技术的日渐成熟和新型封堵器械的不断出现,经导管同期介入治疗儿童复合型CHD引起人们的关注,目前,国内外报道尚不多。该研究对儿童复合型CHD经导管介入治疗的方法及疗效进行探讨。方法：应用经导管介入治疗方法同期封堵治疗8例儿童复合型CHD,其中男4例、女4例,平均年龄(6.1±2.9)岁,其中房间隔缺损(ASD)伴室间隔缺损(VSD)、动脉导管未闭(PDA)1例,ASD伴PDA、肺动脉瓣狭窄(PS)1例,ASD伴PDA 1例,卵原孔未闭(PFO)伴PS 1例,ASD伴PS 4例。经导管介入治疗的原则是:ASD伴VSD、PDA者,先行VSD封堵术,再行PDA封堵术,最后行ASD封堵术;ASD伴PDA、PS者,先行经皮球囊肺动脉瓣成形术(PBPV)纠正PS,再行PDA封堵术,最后行ASD封堵术;PFO伴PS和ASD伴PS者,先行PBPV纠正PS,其次行PFO或ASD封堵术。结果：8例复合型CHD均1次治疗成功,术中未发生任何严重并发症。术后即刻超声和造影检测显示VSD、ASD及PDA均无残余分流,6例合并PS者,跨肺动脉瓣压差由术前的75.3±15.6 mmHg下降至术后的14.0±5.6 mmHg,经3.4±1.2年随访证实无残余分流,跨瓣压差均在通常标准良好的范围内,无任何并发症发生。结论：经导管介入治疗儿童复合型CHD技术要求较单纯型CHD相对高,宜遵循先难后易、后期操作不影响前面治疗的原则,规范操作,可获良好的治疗效果。     

Transcatheter closure of patent ductus arteriosus in pediatric patients

A "double disk" occlusion device (Rashkind PDA occluder system) has been designed to allow transcatheter closure of patent ductus arteriosus (PDA). During a 3-year period, we examined 37 infants and children (not premature neonates) with PDA as their only significant cardiovascular defect. Seventy-eight percent of these patients were considered potential candidates for the use of the PDA occlusion device, and it was successfully placed in all but 2 of 27 patients who underwent cardiac catheterization (PDA too small in one and too large in one). Only one of the remaining 25 patients had a significant residual shunt after placement of the device, which therefore was removed in the catheterization laboratory before surgical ligation of the PDA. There was no clinical evidence of a residual PDA in any patient. The duration of hospitalization was less than 24 hours for each of the last 20 procedures. Echocardiography demonstrated return to normal chamber dimensions in all patients, but a tiny, clinically undetectable residual leak around the device was found in three patients by Doppler evaluation. The transcatheter procedure was preferred over surgery by more than 90% of families and can be completed with a much shorter hospitalization than surgical ligation. We conclude that transcatheter closure of patent ductus arteriosus is feasible in the majority of children with PDA.     

儿童继发孔型房间隔缺损的介入治疗

目的　探讨儿童继发孔型房间隔缺损 (atrialseptaldefect ,ASD)封堵术的指征、方法学和并发症的预防。方法　 1998年 10月～ 2 0 0 3年 1月 ,119例继发孔型ASD患儿 ,根据家属意愿接受了经导管应用Amplatzer房间隔封堵器的介入治疗。年龄 0 8～ 17 0岁 ,平均 ( 7 5± 2 8)岁 ,体重6 7～ 88.0kg ,平均 ( 2 3 7± 7 8)kg。所有病例术前检查被证实均为继发孔型ASD。按ASD球囊伸展直径或大于 1～ 2mm选择封堵器进行堵塞。其中 3例为多发ASD。 6例合并动脉导管未闭 ( patentductusarteriosus,PDA)或肺动脉瓣狭窄 ( pulmonarystenosis ,PS)者应用其他封堵装置和球囊扩张治疗合并的畸形。术后定期行心脏超声及临床检查随访。结果　 119例患儿术前经食道超声(transesophagealechocardiography ,TEE)或经胸超声 (trans thoracicechocardiography ,TTE)检测ASD平均直径 ( 12 9± 5 6 )mm ( 6 5～ 34 5mm ) ,肺动脉平均压力为 ( 2 9 0± 5 0 )mmHg( 2 5 0～ 6 2 0mmHg) ,球囊伸展直径为 ( 15 7± 4 8)mm( 8 0～ 38 0mm)。所选封堵器直径平均为 ( 15 0± 5 0 )mm( 8 0～ 38 0mm)。 112例封堵成功。 3例多发ASD也选用单一封堵器。 6例合并PDA或PS者同时完成介入治疗。 112例堵塞后即刻封堵率为 93 8% ( 1     

Transcatheter Amplatzer Occlusion and Surgical Closure of Patent Ductus Arteriosus: Comparison of Effectiveness and Costs in a Low-Income Country

The goal of this study was to compare the effectiveness and cost of transcatheter Amplatzer occlusion with those of surgical closure for patent ductus arteriosus (PDA) in a low-income country, China. Although transcatheter Amplatzer occlusion for PDA has been increasingly performed, surgical PDA closure is still a routine procedure at many hospitals in China. Therefore, the selection of treatment modality for patients with PDA who could undergo either treatment option is controversial. The treatment of patients with PDA from February 2005 to February 2007 was analyzed retrospectively. A total of 130 patients underwent surgical closure for PDA, whereas 51 patients underwent Amplatzer occlusion. There were no deaths and no residual left-to-right shunting in either group at last follow-up. In total, 2% of patients with complications requiring management underwent Amplatzer device closure and 6.2% surgical closure. The mean hospital stay was 3.6 ± 1.5 days for the device group and 8.8 ± 2.3 days for the surgical group (p < 0.001). The cost with surgical closure was 26% less than that with Amplatzer device closure (13,841.2 ± 3630.3 vs. 18,708.7 ± 1816.5 Renminbi [Chinese currency]; p < 0.001). In conclusion, although transcatheter Amplatzer device occlusion is as effective as and less invasive than surgical closure for PDA, surgical closure is less costly. In low-income countries such as China, where health-care resources are limited, PDA closure with the Amplatzer duct occluder device is not cost-effective.     

经导管Amplatzer封堵器治疗小儿动脉导管未闭的随访结果

目的总结经导管Amplatzer封堵器(Amplatzerductoccluder,ADO)治疗小儿动脉导管未闭(patentductusarteriosus,PDA)的远期随访结果,进一步评价应用ADO治疗小儿PDA远期疗效和安全性。方法对1998年4月至2003年12月间接受ADO封堵术的PDA患儿进行回顾性队列研究。结果共有250例PDA患儿接受ADO封堵术,平均年龄5.3(3个月～16岁)岁,平均体重15.1(3.5～35.0)kg。PDA最窄处直径在1.8～11.0mm之间,平均(4.2±1.5)mm,其中52例(20.0%)直径超过5mm。PDA均应用4～14mm大小的ADO进行封堵,输送长鞘为6F(205例)或7F(45例)。250例中,ADO成功植入245例(98.0%)。Qp/Qs从1.90±0.60降至1.03±0.21(P<0.05)。不同形状的PDA均可应用ADO进行封堵。近期并发症5例,其中溶血3例,股动脉血栓2例,无死亡病例。共有205例在堵闭术后完成1天～60个月的随访,随访率为82.0%。残余分流率在不同随访时间点分别为9.2%(1天)、2.8%(1个月)、1.2%(6个月)、0.8%(12个月)、0(24个月)、0(36个月)、0(48个月)、0(60个月)。5例(2.0%)随访中因残余分流出现溶血或无溶血需要再次接受治疗,随访1年和5年无事件发生率为98.0%。结论应用ADO治疗小儿PDA远期疗效确切,安全性好。     

Transcatheter Occlusion of Residual Patent Ductus Arteriosus After Surgical Ligation

The reported frequency of residual leaks after surgical ligation of patent ductus arteriosus (PDA) varies from 6% to 23%. Reports on percutaneous closure of PDA also involve patients with residual PDA after ligation, but specific data regarding this type of PDA are rare. Our objective was to assess retrospectively the characteristics of residual PDA relevant to transcatheter closure and occlusion results using three types of occluders. Twelve consecutive patients underwent transcatheter occlusion of residual PDA after surgical ligation at a median age of 4.6 years (range 3.2–44.6 years) and median weight 16.5 kg (range 13–62 kg). Three types of occluder were used: Gianturco coils, detachable Cook PDA coils, and the new Amplatzer duct occluder. The median diameter of residual PDA after ligation was 1.5 mm (range 0.9–4.2 mm). All PDAs were of type A morphology. Thirteen devices were successfully placed in the 12 patients, without embolization. There were no complications. At 1 month and 1 year follow-up all residual shunts were completely closed. Coils are particularly suitable for complete closure of residual leaks after surgical ligation of PDA. A 100% closure rate was achieved with a low number of implanted coils.     

四种小儿动脉导管未闭堵闭术的临床应用:附127例报告

本文采用四种不同的介入治疗方法堵闭动脉导管共127例,成功率海绵塞法为92％(23/25例),双面伞器法为98.6％(66/67例),钮扣式补片法为100％(26/26例),弹簧圈器法为100％(9/9例)。海绵塞法和弹簧圈器无残余分流;术后6个月双面伞器法残余分流为7％(5/67例),钮扣式补片法为15％(4/26例)。钮扣式补片法和弹簧圈器法无并发症,海绵塞法为24％(6/25例),双面伞器法为4％(3/67例)。我们认为,钮扣式补片法及弹簧圈器法在小儿动脉导管未闭的介入治疗中具有较大的应用价值。     

Midterm Outcome of Percutaneous Transcatheter Coil Occlusion of Coronary Artery Fistula

The mid- to long-term outcome of pediatric patients with coronary artery fistula (CAF) after transcatheter closure remains unknown. This study reports the midterm outcome of CAF closure by transcatheter Gianturco coil occlusion in pediatric patients. Eighteen patients with CAF confirmed by coronary angiography were seen in our institution. Among them, 4 patients who had persistent coronary artery dilatation received transcatheter Gianturco coil occlusion (age range, 25 months to 12 years; mean, 4.6 years). Two were closed with a single coil, and two were closed with two coils. No residual shunts were detected on follow-up angiography and echocardiography immediately after coil occlusion in all cases. Follow-up Doppler echocardiography (4/4) and angiography (3/4) showed persistent CAF occlusion in all 4 patients. Two of 3 patients with coexistent aneurysmal formation showed obliteration of the aneurysm on angiographic follow-up. In addition, 2 showed resumption of normal coronary arterial size, and 2 showed decrement of the coronary arterial diameter. All 4 patients had normal ECG findings after 26–83 months (mean, 49 months) of follow-up, and all were in NYHA functional class I. The midterm outcome of percutaneous transcatheter coil occlusion in the treatment of CAF is excellent.     

室间隔缺损并主动脉瓣脱垂患儿的介入治疗及疗效评价

目的探讨室间隔缺损(VSD)并主动脉瓣脱垂(AVP)介入治疗的安全性和可行性。方法选择2007年5月-2009年4月在本院住院的VSD并轻度AVP患儿43例,均行经皮VSD堵闭术,经胸超声心动图显示VSD位置及内径,左心室造影均显示VSD并AVP,造影显示VSD大小为2.6～8.3 mm。其中19例为嵴内型(又称膜周流出道型),15例为隔瓣后型,9例为膜周部。右冠瓣脱垂27例,无冠瓣脱垂12例,右冠瓣并无冠瓣脱垂4例,并局限主动脉瓣返流8例。术后进行超声心动图、心电图的随访观察。结果36例成功封堵VSD,封堵成功率83.7%;7例试封堵后再次行左心室及主动脉造影,显示主动脉瓣下有明显切迹,瓣膜返流加重而放弃堵闭术,择期进行外科手术。采用偏心封堵器15例(5～12 mm),大边小腰封堵器(4～14 mm)16例,普通对称型封堵器(5～10 mm)5例。术后即刻造影有微量残余分流4例,原有的主动脉瓣返流无明显加重;随诊3～18个月,超声心动图示4例残余分流,分别在术后3～6个月消失,主动脉瓣局限返流无进一步增加,其中6例返流减少,未出现三尖瓣狭窄、主动脉瓣狭窄及主动脉瓣穿孔,心电图示无Ⅲ度房室传导阻滞等严重心律失...