经导管封堵动脉导管未闭介入治疗后残余分流

目的探讨经导管封堵动脉导管未闭(PDA)介入治疗后残余分流的可行性和临床疗效。方法自1997年3月至2001年8月16例PDA介入治疗后残余分流的患者,其中男4例,女12例,平均年龄5.9±2.4岁(2～9岁),平均体重17.7±5.4kg(9～28kg),应用不同介入方法经动脉或静脉途径封堵残余分流,首次介入治疗与再次介入治疗的时间间隔平均为1.5±1.1年(1天～3.5年)。结果残余分流直径平均为2.7±0.9mm(1.2～5.0mm)。15例成功完成残余分流封堵术,1例失败,技术成功率为94%(15/16)。单纯应用Cook可控弹簧圈9例(其中双弹簧圈2例),Rashkind双面伞2例,Sidris纽扣式补片1例,Amplatzer蘑菇伞2例,同时应用Cook可控弹簧圈和Sidris纽扣式补片1例。封堵术后即刻造影,3例仍有少量残余分流,完全闭合率为80%(12/15)。平均手术时间为75.0±22.8min(45～120min),平均X线透视时间为10.4±3.9min(5～20min)。股动脉并发症1例,其余无并发症出现。封堵术后24h复查超声心动图,所有残余分流均完全闭合(100%),在平均2年随访中未出现残余分流再通、封堵器移位和左右肺动脉狭窄。结论经导管封堵PDA介入治疗后残余分流安全、疗效确切、创伤小,可作为外科手术治疗PDA介入治疗后残余分流的一种替代方法。

Transcatheter occlusion of residual shunt after interventional therapy of patent ductus arteriosus

Objective To explore the feasibility and efficacy of transcatheter closure of residual shunts after interventional therapy of patent ductus arteriosus (PDA). Methods A total of 16 patients (12 females, 4 males) with residual shunt after the first interventional therapy underwent transcatheter closure of residual shunt using different devices by arterial or venous route from March 1997 to August 2001. The median age was 5.9 years (range 2-9 years) and median weight was 17.7 kg (range 9-28 kg). The mean interval between the first procedure and the second procedure was 1.5 years (range 1 d-3.5 yr). Results The median minimal diameter of residual shunt was 2.7 mm (1.2-5.0 mm). Transcatheter occlusion was successfully performed in 15 patients and the success rate reached to 94% (15/16). Eleven Cook detachable coils, two Amplatzer Duct Occluders (ADO), one Sideris device, and two Rashkind devices were placed in 9 (two coils in 2 patients), 2, 1, and 2 patients respectively. One Sideris device and one Cook detachable coil were placed in one patient simultaneously. The complete occlusion rate of the residual shunts was 80% (12/15) assessed by angiography immediately. The mean procedure time was 75 min (45-120 min) and the mean fluoroscopy time was 10.4 min (5-20 min). All residual shunts were found to be completely closed 24 h after the procedure by echocardiography. Complication was encountered in one patient with loss of the pulse of the femoral artery. There were no device migration and pulmonary arteries obstruction in all patients at mean 2 years follow-up. Conclusion Transcatheter closure of residual shunt after the first interventional therapy is a feasible, effective alternative of surgical procedure.