动脉导管未闭个体化介入治疗的初步尝试

目的评价动脉导管未闭(PDA)个体化介入治疗的临床应用价值。方法8例应用标准型Amplatzer导管封堵器难以完成介入治疗的PDA患者,根据造影显示PDA形态及临床特点,分别选用成角型Amplatzer导管封堵器、偏心型导管封堵器以及Amplatzer肌部室间隔缺损封堵器进行介入治疗,术后以心脏超声随诊评价疗效。结果8例患者皆成功完成介入治疗,无严重并发症发生;其中1例应用Amplatzer肌部室间隔缺损封堵器、2例应用成角型Amplatzer导管封堵器、5例应用偏心型导管封堵器;2例经2次手术完成,余患者一次治疗完成;8例患者中,有2例封堵后即刻造影显示封堵完全,4例术后2 4h心脏超声检查无残余分流,7例术后3月残余分流消失;1例术后6个月时心脏超声仍可见约2mm的残余分流,但肺动脉压力明显下降,患者主观症状明显减轻。结论个体化原则可以进一步扩大PDA介入治疗的适应证,临床实践需要设计和生产不同形态和大小的封堵装置。

Transcatheter closure of patent ductus arteriosus: initial clinical experience of individual approach

Objective:To assess the clinical values of the individual approach for the transcatheter closure of patent ductus arteriosus(PDA).Methods:8 patients with PDA which failed to be closured by standard Amplatzer duct occluders underwent transcatheter closure with different devices according to the angiocardiography conformation and the clinical manifestation. The devices including angled Amplatzer duct occluder, asymmetric duct occluder and Amplatzer muscular ventricular septal defect occluder. All patients were studied by transthoracic color Doppler echocardiography at 24 hours, one, three and six months after occlusion.Results:Different occluders were successfully implanted in all patients, including 1 Amplatzer muscular ventricular septal defect occluder, 2 angled Amplatzer duct occluders and 5 asymmetric duct occluders. There were no serious complications. 2 patients received another closure procedure because of no suitable occluders on hand in the first time procedure, the others completed at one time. Immediate complete PDA closure was achieved in 2 patients. Color Doppler echocardiography showed no residual shunt in 4 patients after 24 hours, and in 7 patients after 3 months. In 1 of the 8 patients, there still had a 2mm residual shunt after 6 months by echo follow up, but the pulmonary artery pressure decreased significantly.Conclusion:Clinical practice for the transcatheter closure of PDA demand different kinds of devices because of the varied angiography types, more patients with PDA would benefit from the individual approach.