介入治疗儿童动脉导管未闭和房间隔缺损

目的:评价应用Amplatzer封堵器治疗儿童房间隔缺损(ASD)和动脉导管未闭(PDA)的效果、安全性及并发症等。方法:超声心动图及临床诊断为ASD、PDA患儿,在透视或(和)经胸超声心动图(TTE)下置入Amplatzer封堵器,术后24 h、1、3、6个月、1年及以后每年分别经胸超声、心电图和X线胸片检查评价治疗效果。结果:16例ASD患儿,球囊测量值为13.0～28.0 mm(19.3±4.9)mm],选择封堵器的直径为13.0～30.0 mm(20.6±5.1)mm];25例PDA患儿,造影测量值为2.0～7.7 mm(3.9±1.5)mm],选择封堵器的直径为4.0～12.0 mm(6.6±1.9)mm]。技术成功率为100％,术中未发生任何并发症,无急诊手术病例。术后即刻造影或TTE显示10例存在残余分流,术后3月TTE检查所有病例无残余分流和再通,肺动脉压下降。结论:应用Amplatzer封堵器治疗小儿PDA和ASD,具有操作简单、安全、损伤小、成功率高等优点,适合于儿童继发孔型ASD及各种类型PDA的介入治疗。

Transcatheter to Close the Patent Ductus Arteriosus and Atrial Septal Defects in Children

Objective: To evaluate the therapeutic efect, safety and complications of transcathetering Amplatzer device in the closure of patent ductus arteriosus ( PDA ) and atrial septal defects ( ASD ) in children. Methods: Patients with PDA ( n= 25 ) and ASD ( n =16), confirmed by echocardiography, were treated by transcatheterization. Amplatzer occluder device was placed by the transcatheterization with the image support of X-ray and transthoracic echocardiography (TTE) . The TTE , ECG and X-ray examination were engaged to evaluate the therapeutic results on the time points of 24 h, 1, 3, 6, 12 months after the operation, and all these cases were engaged to the follow-up examination. Results: The cardioangiographic diameter was 13.0-28.0 mm (19.3 ±4.9] mm) inASD and 2.0-7.7 mm (3.9± 1.5] mm)in PDA. The diameter of the Amplatzer occluder selected were 13.0- 30.0 mm ( 20.6 ± 5.1]mm) in ASD and 4. 0- 12.0 mm ( 6.6 ± 1.9] mm) in PDA , respectively. All the Amplatzer occluders were placed successfully. There were no complications during and after the operation.Very small residual shunt was still found soon after the operation in 10 cases, and there were no residual or recanalization after three months of the operation. The pulmonary artery pressure and heart size were significantly decreased in follow-up examination. Conclusion: Transcathetering closure with Amplatzer device is an effective, simple and safe technique in the treatment of ASD and PDA in children.