四种小儿动脉导管未闭堵术的临床应用：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，成功率地为９２％，双面伞器法为９８．６％，钮捉弄式补片法为１００％，弹簧圈器法为１００％。     

经心导管关闭动脉导管的临床比较

本文对常用的经心导管填塞动脉导管未闭（ＰＤＡ）四种方法从适应证，方法，疗效和并发症等几方面进行了比较，Ｐｏｒｓｔｍａｍｎｎ的方法如果塞子与导管的匹配良好，则疗效肯定，无残余分流，但操作复杂，对股动脉损伤较大，适应证较窄。Ｒａｓｈｋｉｎｄ的双伞闭合器和Ｓｉｄｅｒｉｓ的扣式闭合器疗效相似，适应证较广，对股动脉损伤较小，相同的并发症为残余分流。Ｇｉａｎｔｕｒｃｏ的螺旋闭合器主要适应于小直径的ＰＤＡ，操作     

第二代动脉导管未闭封堵器封堵动脉导管的临床研究

目的评估新型动脉导管未闭封堵器(Amplatzer duct occluder-Ⅱ,ADOⅡ)治疗各种类型动脉导管未闭(PDA)的可行性和效果。方法选择2011年2月—2011年7月间确诊为PDA且无治疗禁忌证、应用ADOⅡ行介入治疗者26例,根据造影、心脏超声检查和肺动脉压力选择合适的ADOⅡ,参考动脉导管类型、导管最狭窄处直径和主动脉端壶腹部大小分别选择顺向法和逆向法释放封堵器。释放前常规行降主动脉造影观察封堵器位置是否合适,以及有无残余分流;心脏超声观察有无左肺动脉和降主动脉狭窄。术后1 d行心脏超声检查,无异常术后第2天出院。1、3、6个月时门诊随访,随访时行心电图和心脏超声检查。结果 26例介入治疗者,男11例、女15例,平均年龄(2.99±1.63)岁(0.5～6.0岁),平均体质量(14.47±4.24)kg(6.5～24.0 kg),平均肺循环血流量/体循环血流量(Qp/Qs)1.73±0.47(1.2～2.4),导管最狭窄直径平均(1.78±0.71)mm(1.2～3.6 mm)。采用顺向释放18例,逆向释放8例。2例术后超声有少量残余分流;1例出现主动脉相对狭窄,升主动脉到降主动脉压差为1...     

经心导管关闭动脉导管的临床比较

本文对常用的经心导管填塞动脉导管未闭（ＰＤＡ）四种方法从适应证、方法、疗效和并发症等几方面进行了比较。Ｐｏｒｓｔｍａｎｎ的方法如果塞子与导管的匹配良好，则疗效肯定，无残余分流，但操作复杂，对股动脉损伤较大，适应证较窄。Ｒａｓｈｋｉｎｄ的双伞闭合器和Ｓｉｄｅｒｉｓ的扣式闭合器疗效相似，适应证较广，对股动脉损伤较小，相同的并发症为残余分流。Ｇｉａｎｔｕｒｃｏ的螺旋闭合器主要适应于小直径的ＰＤＡ，操作简单，疗效确切，是近几年应用较广的治疗方法。     

经导管弹簧圈堵闭治疗小儿动脉导管未闭

目的评价经导管弹簧圈堵闭小儿动脉导管未闭（ＰＤＡ）的效果。方法１９９７年１月～１０月堵闭治疗２５例ＰＤＡ患儿，年龄１５～１４０岁，平均６８±２７岁；体重１０～３７ｋｇ，平均１９７±７９ｋｇ。ＰＤＡ最窄处直径１３～２８ｍｍ，ＰＤＡ长度５０～１０９ｍｍ；形态有短管型、长管型、漏斗型。采用美国Ｃｏｏｋ公司生产的３种弹簧圈堵闭ＰＤＡ。结果成功率为１００％，术后心血管造影显示，８０％（２０／２５）患儿有极少量残余分流，术后２４小时彩超复查仅有２例有少量残余分流，术后１个月彩超复查无一例有残余分流。结论经导管弹簧圈堵闭小儿ＰＤＡ，是较安全且创伤小的非开胸方法，适用于婴幼儿，特别是ＰＤＡ最窄处直径在３ｍｍ以内的患儿     

经导管介入性治疗小儿先天性心脏病12例报告

目的：应用导管介入性治疗小儿多种先天性心脏病并对其疗效进行初步评价。方法：全组共12例,行肺动脉瓣球囊成形术3例。多方法堵闭动脉导管未闭7例。2例继发孔中央型房间隔缺损分别采用Sideris(纽扣式)补片及Amplatzer堵闭装置各1例。结果：全组技术成功率为100%。术后随访1月至2年,其中1例房间隔缺损有少量残余分流。结论：应用导管介入治疗小儿先天性心脏病是有效的非手术治疗方法。     

经导管钮扣式补片法治疗小儿先天性心脏病

经导管钮扣式补片法治疗小儿先天性心脏病广东省心血管病研究所（广州，５１０１００）王慧深钱明阳李渝芬张智伟潘宝全自１９９０年Ｓｉｄｅｒｉｓ等［１］首次报道经导管钮扣式补片法关闭房间隔缺损（ＡＳＤ）后，１９９１年此技术用于动脉导管未闭（ＰＤＡ）［２］，１...     

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.     

动脉导管未闭三种堵闭方法的比较

为比较动脉导管未闭三种堵闭方法的疗效，１９８９年３月～１９９４年１２月分别采用Ｐｏｒｓｔｍａｎｎ法、Ｒａｓｈｋｉｎｄ法及Ｓｉｄｅｒｉｓ法堵闭动脉导管未闭（ＰＤＡ）共５６例。其中Ｐｏｒｓｔｍａｎｎ法２３例，成功率９２％（２３／２５例）；Ｋａｓｈｋｉｎｄ法２３例，成功率１００％（２３／２３例），Ｓｉｄｅｒｉｓ法８例，全部成功。结果是：三种方法比较以Ｐｏｒｓｔｍａｎｎ法疗效最好，对２３例成功堵闭ＰＤＡ的患儿经３年随访，无一例有残余分流，但其适应证范围小，且并发症较多；Ｒａｓｈｋｉｎｄ法和Ｓｉｄｅｒｉｓ法适应证范围广，操作简便，但术后２４小时残余分流发生率较高，分别为２６％（６／２３例）和２５％（２／８例）。提示，后两种方法值得改进后推广应用。     

残端样管状动脉导管未闭的介入治疗

目的探讨吸收性明胶海绵封堵残端样管状动脉导管未闭(PDA)即刻和早期疗效。方法选择残端样管状PDA,且其肺动脉侧破口直径<0.5 mm,分流少患儿2例。人为制造出一管状动脉导管盲端,在未闭动脉导管内释放压缩呈条状的吸收性明胶海绵。结果血栓形成达到封堵残端样管状未闭动脉导管的作用。结论吸收性明胶海绵治疗残端样管状PDA操作简单、疗效确切。     

Comparison of cost and clinical outcome between transcatheter coil occlusion and surgical closure of isolated patent ductus arteriosus

OBJECTIVE: The objective of this study was to compare the cost (measured as resource utilization by the institution) and clinical effectiveness of transcatheter coil occlusion and surgical patent ductus arteriosus (PDA) closure. Similar comparisons have been made previously with other devices no longer in use in the United States. No such comparison has been made for coil occlusion, which has been performed increasingly since 1992. METHODS: All patients who underwent either coil or surgical closure of uncomplicated PDA at our institution between August 1993 and June 1996 were retrospectively identified. Patients were included in the study if they were eligible for either closure technique. Thus, they had a restrictive PDA (not associated with pulmonary hypertension) and no overt evidence of congestive heart failure. Patients were excluded if they had other significant cardiac or noncardiac problems. Total procedural and recovery costs (including labor, material, equipment, and overhead) incurred by the provider were determined using a cost accounting system called Transition Systems, Inc. To define further how costs differed for the two techniques, total costs were subdivided into the categories of professional, technical, inpatient hospital stay, postprocedure testing, and supplies and other miscellaneous costs. PDA closure rates and associated complications also were compared. Follow-up information was sought from outpatient visits to our institution or by contacting the referring physicians. RESULTS: A total of 39 patients were identified, 3 of whom were excluded because of coexisting medical problems. The study group consisted of 36 patients; 24 underwent PDA coil occlusion and 12 surgical closure. Mean age and weight were 8.8 years and 28.5 kg for the coil patients, and 7.3 years and 32.8 kg for the surgical patients. Median procedural duration was 150 minutes for the coil group and 165 minutes for the surgical group. The total cost to the institution of coil occlusion was significantly lower than that of surgical closure ($5273 vs $8509). The largest difference lay in the cost of hospital stay ($398 vs $2566) and in the professional costs ($1506 vs $2782). Technical costs were similar ($2156 for coil, $2151 for surgery), although use of the catheterization laboratory per unit of time was more expensive than use of the operating room ($800 vs $400 per hour). Additional technical costs of the surgical procedure related to general anesthesia and postoperative care made up the difference. No patient in either group had a residual PDA murmur at hospital discharge or thereafter. Follow-up echocardiography was performed in all coil occlusion patients, and tiny residual leaks were detected in 17%. Only 42% of the surgical patients had postoperative echocardiography; none had residual leaks. There were no deaths or major complications in either group. CONCLUSIONS: Transcatheter coil occlusion is as effective and less costly than surgical closure if silent residual leaks are not considered clinically significant. This information may be used increasingly in patient care decisions in the current era of managed medical care.     

Transcatheter occlusion of the persisting arterial duct

BACKGROUND: Transcatheter occlusion of the persisting arterial duct (PDA) is feasible using different techniques like coil-embolization (CE), Rashkind PDA occluder (Rash), Amplatzer Duct Occluder (ADO). Comparative studies with this devices in relation to the size of the PDA and the device are missing. Aim of this study was to evaluate the different systems at the own patient population. PATIENTS AND METHODS: From 1993 to 12/2001 transcatheter occlusion was attempted in 92 patients aged 4,13 years (range 0,07 to 14,39 years) using CE, Rash or ADO. All patients received echocardiographic examinations 24 hours before and after intervention, after 3, 6, and 12 months and than yearly. RESULTS: 91/92 PDAs could be successfully closed by 97 interventions. There were 63 CE, 25 Rash and 9 ADO performed. Primary closure rate was 75 % for Rash, 80 % for ADO and 80,8 % for CE (n. s.) and after 6 months 88 % for Rash, 92,3 % for CE and 100 % for ADO (p < 0,001), although the size of the PDA increased significantly from CE (2,14 + 1,1 min) to Rash (3,2 +/- 1,3 min) to ADO (4,9 +/- 1,9 min) (p < 0.05). In 6/7 pts with residual shunts complete occlusion could be achieved by second intervention. CONCLUSION: In dependency of the size of the PDA and the right choice of the occluder almost all PDAs are closable with transcatheter techniques.     

Transcatheter Closure of Patent Ductus Arteriosus Among Native High-Altitude Habitants

Increased prevalence of patent ductus arteriosus (PDA) at high altitude (HA) is a known occurrence. Transcatheter treatment of patients with PDA living at a HA is assessed in this study. Thirteen consecutive patients (all habitants of La Paz, Bolivia) underwent transcatheter closure of PDA. The minimal diameter of PDA was 5.8 (1.5–11) mm and the mean pulmonary artery pressure was 37 (7–80) mm Hg. In 12 patients, the Amplatzer Duct Occluder (ADO) was used; in one child with PDA with a 1.5-mm diameter, a detachable coil was implanted. All procedures, except for one, were completed successfully. The ADO (diameter: 12/10 mm) implantation failed in one child with pulmonary hypertension because the device could not be properly secured in position in a 6-mm PDA. Subsequent surgery was performed without any complications. No residual shunt after 24 h was observed in any case after treatment. No complications were encountered during the procedure and follow-up of 1.5 (from 0.1 to 2.8) years. PDA in native residents of high land have different physiopathologies and anatomies. ADO appears to be a suitable device for transcatheter occlusion for most such patients. Interventional cardiology in countries with residents at high altitudes can be helpful in addressing this issue.     

Percutaneous Transaortic Occlusion of Patent Ductus Arteriosus Using a New Versatile Angiographic and Delivery Catheter

We evaluated the usefulness of patent ductus arteriosus (PDA) occlusion using a new catheter that combines good angiographic properties, easy manipulation across the duct, documentation of aortic and pulmonary artery pressure, and coil delivery for percutaneous transaortic ductal occlusion. Thirty patients (13 females and 17 males) who met the clinical and echocardiographic criteria for the percutaneous closure of PDA were catheterized. The patients selected for this study had a small to moderate PDA with a conal or tubular shape, adequate aortic ampula, and normal or mildly elevated pulmonary artery pressure. The median age was 4.8 years (range, 10 months–20 years). Patients were catheterized by the transaortic approach using the new angiographic and coil delivery catheter specially designed for this procedure. A PDA was closed in every case. A single DuctOcclud pfm coil was delivered in 28 patients, and 2 patients had NitOcclud pfm coils for ductal occlusion. The screening time was measured and found to be 50% less than the measured screening time using other catheters in our laboratory. Only one catheter and one guidewire were used per procedure, with no need for exchange wires or the establishment of an arteriovenous loop. The procedure time was also reduced by 50%. A minimal residual shunt, demonstrated by color-flow Doppler mapping, was present in 2 patients. The new combined angiographic and coil delivery catheter is most suitable for transaortic PDA coil occlusion, significantly decreasing the procedure and screening time.     

先天性心脏病复合畸形的介入治疗

目的探讨介入治疗小儿先天性心脏病(CHD)复合畸形的可行性和疗效。方法对CHD复合畸形患儿10例施行联合介入治疗,其中房间隔缺损(ASD)并肺动脉瓣狭窄(PS)2例,室间隔缺损(VSD)并动脉导管未闭(PDA)4例,PDA并PS 2例,ASD并PDA 2例。结果7例1次治疗成功,余3例中2例分2次治疗,1例8个月患儿,因其在最初0.5年随访中发现VSD明显缩小,故先封堵了PDA,目前正在随访中。成功率100%,无严重并发症。经1个月-3年随访,患儿心脏缩小,心脏功能改善。结论在病例选择恰当情况下,对小儿CHD复合畸形进行介入治疗是安全、可行的。     

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.     

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。     

Mechanical Occlusion of the Patent Ductus Arteriosus with Jackson Coils

The effectiveness and safety of a protocol for transcatheter patent ductus arteriosus (PDA) closure was assessed. Our goal is complete mechanical occlusion of the PDA in the catheterization laboratory by adding coils until it is no longer possible to cross the PDA with a guidewire. Detachable coil closure of a PDA with a narrowest diameter of 2.4 ± 0.1 mm was attempted in 83 patients with a median age of 2.8 years (0.7 to 27.8 years) and whose median weight was 14.5 kg (6 to 61.6 kg). Coils were successfully implanted in 82 of 83 patients, and in 1 patient a large Rashkind double umbrella was used instead. Complete closure was obtained in 80 (97.6%) patients, 48 of those (59%) received more than one coil. Reintervention for residual shunting was required in only 1 patient and another patient has a trivial residual shunt. Device embolization occurred in three cases. Despite the use of multiple coils there was no evidence of significant left pulmonary artery stenosis. The fluoroscopy time increased from 14.0 ± 2.0 minutes for a single coil to 25.3 ± 2.9 minutes for multiple coils (p < 0.01). Attempting to obtain complete mechanical occlusion of the PDA during the implant procedure by adding extra coils reduces the need for reintervention for residual or recurrent shunting.     

Non-surgical closure of patent ductus arteriosus with the Rashkind PDA occluder system.

Transcatheter closure of Patent Ductus Arteriosus (PDA) was done in 18 children using the USCI Rashkind PDA occluder system. Patient age ranged from 1.2 to 14 years and their weights ranged from 8 to 36 kg. Isolated restrictive PDA was present in 15 patients; 3 had additional cardiac defects. The diameter of the PDA ranged from 2 to 6 mm as determined by lateral aortogram. PDA occlusion was successfully done in all 18 children. Ten 12 mm and eight 17 mm occluders were implanted with no complications. Post-implant aortogram showed complete ductal closure in 6 and trivial or small residual ductal flow in 12 cases. Doppler color flow mapping done within 3 days of the procedure showed complete ductal closure in 9, 8 had trivial ductal flow and 1 had small ductal flow. Transcatheter technique using a Rashkind PDA occluder system is a safe and effective method of non-surgical PDA occlusion.     

Catheter closure of moderate to large sized patent ductus arteriosus using the simultaneous double or triple coil technique

BACKGROUND: Although the clinical experience with transcatheter closure of the patent ductus arteriosus using the coils has grown rapidly, one important complication of this procedure using the conventional Gianturco coil was the migration of coils into peripheral vessels. This is especially for patients with a relatively larger size ductus and the risk for such complications could be increased. In this situation, the detachable coil may have some technical benefits to perform coil occlusion and reduce the incidence of complications. METHODS: We describe the clinical efficacy of a simultaneous double or triple coil occlusion technique using the Cook detachable coil or bioptome delivered 0.052 inch Gianturco coil to close the ductus arteriosus. This was performed in patients whose ductus diameter was greater than 3.0 mm. RESULTS: From February 1995 to December 2000, 118 patients with patent ductus arteriosus were treated by coil occlusion using Cook detachable coils, of whom 58 patients whose minimum diameter of ductus > or = 3.0 mm were reviewed. All patients had successful placement of coils. According to the evaluation by color flow mapping, a trivial shunt was observed in 17 patients (29%) within 24 h after the procedure. In 11 out of 17 patients, a residual shunt was not detected 1 month after the procedure. At 6 months after the procedure, the residual shunt was detected only in three patients. CONCLUSIONS: Although this study did not calculate the statistical significance between detachable and non-detachable coils in term of occlusion rate, our institutional experience suggests that the simultaneous double or triple coil technique using the detachable or 0.052 inch Gianturco coils can reduce the prevalence of coil migration or complications.