蘑菇伞封堵器介入治疗婴幼儿动脉导管未闭的临床疗效研究

目的：评价蘑菇伞封堵器经导管介入治疗婴幼儿动脉导管未闭（patent ductus arteriosus，PDA）的临床疗效．方法：2002—12／2008-06我科对婴幼儿PDA78（男28，女50）例实施经导管介入治疗，年龄8—36（15．8±5．6）mo，体质量7．8—17．5（12．0±4．3）kg；行右心导管检查测定肺动脉压力、主动脉压力，行主动脉弓降部造影，确定PDA位置、形状及大小，PDA最窄处内径1．5—14．3（4．3±3．1）mm．以蘑菇伞堵堵器行介入治疗．术后24h及1，3，6，12mo行彩色多普勒超声心动图检查．结果：78例患儿中74例（94．9％）封堵器植入成功．1例主动脉造影后PDA粗大（14．3mm），呈C型，采用最大型号封堵器轻易拉过PDA，该例放弃封堵术，转外科手术治愈．1例为PDA封堵器主动脉侧过大，导致降主动脉局部狭窄、迂曲变形而放弃封堵．1例PDA并发重度肺动脉高压试封堵后30min肺动脉收缩压无下降，反而有轻度上升，考虑为阻力性重度肺动脉高压，撤出封堵器．1例封堵术后封堵器周围大量残余分流，行外科手术治疗．余74例术后30min主动脉弓降部造影显示52例（70．3％）封堵完全，22例（29．7％）可见极少量残余分流，术后24h心脏彩超复查71例（95．9％）封堵完全，3例（4．1％）有少量残余分流，术后1mm彩超复查皆无残余分流；无再通和堵闭器移位等并发症发生．结论：在严格选择适应证的条件下，应用蘑菇伞经导管封堵治疗婴幼儿PDA是一种安全、简便、有效、创伤小、恢复快的方法，值得推广应用．

Catheter closure of patent ductus arteriosus by mushroom shape occluder in infants

AIM： To evaluate the treatment efficiency of catheter closure of patent ductus arteriosus （PDA） by mushrooms occluder in infants. METHODS： Seventy-eight cases of infant PDA （28 males and 50 females ） underwent attempted catheter closure by using mushroom shape oecluder with the median age of （ 15.8 ± 5.6） months（ranging 8 to 36 months） and the mean weight of 7.8 - 17.5 （ 12. 0 ± 4. 3 ） kg. Pulmonary arterial pressure, aortic pressure and oxygen saturation were measured. The mean PDA diameter of narrowest segment was 1.5 - 14.3（4.3 ±3.1） mm by aortography. Lateral descending aortographies were performed to evaluate the immediate results 30 min after the procedure and follow-up evaluations were performed with color flow mapping respectively at 24 h, 1, 3, 6 months and 1 year after closure. RESULTS： The devices were successfully placed in 74（94.9% ） of the 78 cases. Complete angiographic closure was seen 30 rain after the device deployment in 52 of the 74 cases（70.3% ） while small leaks were presented in 22 cases （29. 7% ）. Complete echocardiographic closure was observed in 71 out of the 74 patients （95.9%） at 24 h and 100% at 1 month after the procedure. No PDA recanalization and migration of the devices and no complications were seen after the complete ocelusian during 1-12 months follow-up. CONCLUSION： Catheter closure of infant PDA using the mushroom shape occluder is a safe and effective interventional therapy under strict indication selection.