应用可回收与非回收弹簧圈装置堵塞动脉导管未闭的比较

目的比较应用可回收（ｄｅｔａｃｈａｂｌｅｃｏｉｌ）与非回收弹簧圈（ｎｏｎｄｅｔａｃｈａｂｌｅｃｏｉｌ）堵塞动脉导管未闭（ＰＤＡ）的效果，并探讨影响效果的因素。方法经导管堵塞１８例ＰＤＡ患儿，男４例，女１４例；年龄３～１２岁。ＰＤＡ最狭窄处直径为１．２～３．６ｍｍ（平均２．３ｍｍ）。其中３例ＰＤＡ外科结扎后再通，１例ＰＤＡ伴肺动脉瓣狭窄。结果１８例患儿中７例应用非回收弹簧圈堵塞法，其中５例获成功；１１例应用可回收弹簧圈装置，堵塞均获成功，其中９例应用双圆锥形弹簧圈，另２例采用Ｃｏｏｋ可回收弹簧圈。彩色多普勒显示９例堵塞术２４小时后无分流，２例随访发现极少量分流。结论应用可回收弹簧圈堵塞ＰＤＡ，其效果优于非回收弹簧圈；可适用未经手术及外科结扎后再通的ＰＤＡ患儿。该法简便、有效、安全、并发症少，为堵塞中小型（直径≤３．５ｍｍ）ＰＤＡ值得推荐的方法     

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     

经导管应用弹簧圈封堵术治疗儿童心血管畸形

目的　探讨应用弹簧圈治疗儿童心血管畸形的指征、方法学和并发症的预防。方法　133例心血 管畸形患儿接受了经导管应用弹簧圈封堵术。术后随访,定期行心脏超声。结果　101例动脉导管未闭(PDA)中 应用Gianturco弹簧圈14例,Duct Occlud和Nit Occlud弹簧圈87例,PDA最小直径为1.6±0.6mm(0.5～ 3.8mm)。有4例植入2只弹簧圈。即刻封堵率为90.1%(91/101);1月后封堵率98.0%(99/101),1年后封堵率 99.0%(100/101)。应用Gianturco弹簧圈封堵主动脉至肺动脉侧枝血管14例,直径3.5±0.8mm(2.1～5.0mm), 5例植入1只弹簧圈,9例植入2～4只弹簧圈。14例封堵后10～15min完全封堵。封堵冠状动脉瘘共14例,直径 3.8±1.1mm(2.0～5.1mm),其中右冠状动脉右室和右房瘘8例,左冠状动脉前降支或回旋支右室瘘和右房瘘6 例,10例植入1只Gianturco弹簧圈,2例植入2～4只Gianturco弹簧圈,应用Duct Occlud弹簧圈1例,即刻封堵率 为38.5%(5/13),1月后封堵率84.6%(11/13);1例右冠状动脉右室瘘,在封堵后即刻发生弹簧圈漂移至左肺小 动脉,用异物钳取出后再外科手术。肺动静脉瘘2例,全部应用Gianturco弹簧圈,分别植入6和16只弹簧圈,封堵 后外周动脉血氧饱和度从76%上升至91%和96%。应用Nit Occlud弹簧圈各1只封堵有假性室隔     

应用经导管动脉导管双面伞器堵闭术治疗动脉导管未闭12例

１９９４年５～６月使用Ｒａｓｈｋｉｎｄ动脉导管堵闭系统治疗１２例动脉导管未闭（ＰＤＡ）患儿。年龄４．５～１０岁，平均５．８岁。体重１２．５～２６．５ｋｇ，平均１８．３ｋｇ。漏斗型１０例，管型２例。ＰＤＡ最窄处内经２．２～４．９ｍｍ，平均３．９ｍｍ。１２例堵闭术均一次成功。术后用彩色多普勒超声心动图随诊，术后第２天４例有少量残余分流，术后１个月仅３例有少量残余分流，无一例有并发症。提示该方法Ｐｏｒｓ－ｍａｎｎ有适应证范围广，创伤小，安全有效，成功率高的优点。     

应用Cook弹簧圈和Amplatzer封堵器治疗小儿动脉导管未闭185例分析

Cook可控弹簧圈和Amplatzer动脉导管堵闭器(Amplatzer duct occluder，ADO)是目前国际上多数心脏中心常用的治疗动脉导管未闭(PDA)的方法。我科也先后对Cook可控式弹簧圈和ADO的临床应用进行了评价。现回顾性分析应用两种方法堵闭PDA的患儿，旨在探讨两种堵闭装置在小儿动脉导管堵闭术中的应用价值。     

经导管法堵塞治疗先天性冠状动脉瘘

为探讨先天性冠状动脉瘘非开胸手术疗法，采用经导管法对４例冠状动脉瘘进行堵塞治疗的研究。患儿年龄分别为２．３、６．５、１１及１１岁。３例为右冠状动脉回流入右室腔，１例为左冠状动脉瘘回流入右室。４例均用弹簧圈进行堵塞，其中３例由于采用大于冠状动脉瘘直径３０％的弹簧圈，而获完全堵塞；而另１例由于应用的弹簧圈过小而未能堵塞冠状动脉瘘，弹簧圈漂至左肺小动脉，经手术取出。提示经导管置入弹簧圈堵塞先天性冠状动脉瘘的方法既安全、有效，又方便、经济，可作为替代外科开胸手术治疗冠状动脉瘘的一种方法。     

动脉导管造影联合经胸超声在动脉导管未闭封堵术治疗中的应用

目的：探讨经动脉导管造影联合经胸超声能否作为动脉导管未闭封堵术的一种简化治疗方法。方法：选择欲行动脉导管未闭介入封堵术患儿40例,随机分为观察组20例和对照组20例。对照组应用传统的动脉导管未闭介入封堵技术。观察组采用简化的动脉导管未闭介入封堵术,并借助经胸超声实时监测。结果：观察组20例患儿用简化方法行动脉导管未闭封堵术均一次封堵成功,超声显示封堵器位置良好,左、右肺动脉、降主动脉血流速度均在正常范围内。观察组患儿放射线曝露时间明显少于对照组;观察组患儿无一例与血管穿刺相关的血管并发症发生,但对照组患儿发生4例血管并发症。患儿的恢复时间和滞留于监护室的时间也相应缩短;观察组总的医疗费用少于对照组。结论：经动脉导管造影联合经胸超声行PDA封堵术是一种良好的简化封堵方法。［中国当代儿科杂志,2010,12（2）：103-105］     

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。     

早产儿肺透明膜病伴动脉导管开放的早期诊断

２７例早产儿肺透明膜病（ＨＭＤ）伴呼吸衰竭需要呼吸机治疗者，在２．６９±１．１６天出现动脉导管开放（ＰＤＡ），导管开放时，均有心前区抬举搏动、心音亢强、周围脉搏增强、心脏有杂音、心率增快、脉区差增大，口服消炎痛后，导管关闭。关闭后，心率和脉压差显著下降，ＰａＯ２升高，ＰａＣＯ２下降，与开放时比较均有非常显著差异（Ｐ＜０．００１），提出在ＨＭＤ急性期出现心前区抬举搏动、心音亢强、心率加快、脉压差加大、ＰａＣＯ２升高等，可作为早期诊断动脉导管开放的临床依据。     

蘑菇伞型堵闭器在小儿动脉导管堵闭术中的临床应用

目的　评价一种新的小儿动脉导管未闭（ＰＤＡ） 堵闭装置———自动扩张蘑菇伞形（Ａｍｐｌａｔｚｅｒ）堵闭器的临床应用价值。方法　４９ 例ＰＤＡ 患儿（ 男２１ 例,女２８ 例）,平均年龄３－４ 岁（０－３～１２ 岁） ,体重平均１２－４ ｋｇ（４－５ ～２３－４ ｋｇ） ;ＰＤＡ 大小平均为３－５ ｍｍ（２－１～７－１ ｍｍ）,均用直径为６ ～１０ ｍｍ 的堵闭器进行堵闭。结果　４９ 例患儿均一次堵闭成功,术后２４ 小时彩色多普勒超声心动图检查仅２ 例有少量残余分流。平均手术时间为４２－０ 分钟（３３～５０ 分钟）,平均Ｘ线透视时间为６－５分钟（５～８ 分钟） 。随诊过程中无一例出现任何并发症。结论　采用蘑菇伞形动脉导管堵闭器堵闭ＰＤＡ是一种疗效好、安全、操作简单、适应症范围广的新方法。     

Transcatheter patent ductus arteriosus occlusion: evolution of techniques and results from the 1990s

OBJECTIVE: To review the evolution of transcatheter patent ductus arteriosus (PDA) occlusion techniques and results. METHODS: A single institution, retrospective review including all patients with intention to close a PDA from 1991 to 1998, with no exclusions. RESULTS: Rashkind occluder (n = 65), sideris double-button (n = 6), Cook detachable coil (n = 28) and Amplatzer ductal occluder (n = 4) were used. Successful implantation occurred in 99 of 103 patients. There was a need for a second transcatheter procedure to close residual ductal shunting in 12% of patients: Rashkind umbrellas (n = 8), double-button (n = 1), coils (n = 3). Eight patients (8%) required surgery, including 4 of 6 patients with the double-button occluder. CONCLUSIONS: The Rashkind occluder and the Sideris double-button device both had an unacceptably high rate of residual shunts requiring a second transcatheter procedure or surgical closure. Detachable coils and the Amplatzer ductal occluder have become the current technology of choice for transcatheter PDA closure with high success rates.     

Closure of Conduit Fenestration After Extracardiac Fontan Procedure Using Amplatzer Vascular Plug: Comparison with Detachable Coil

The objective of this study was to report the outcome of fenestration closure using either an Amplatzer Vascular Plug I or detachable coils in patients undergoing extracardiac Fontan procedure with conduit fenestration. We reviewed the medical records of 23 patients who underwent transcatheter closure of conduit fenestration with the extracardiac Fontan procedure. The median age at fenestration closure was 57 months (range 36 to 98). The median interval between the operation and the procedure was 28 months (range 8 to 68). The Amplatzer Vascular Plug I (AVP) was used in 16 patients, and detachable coils were used in 7 patients. In the coil group, we used 1 coil in 3 patients, 2 coils in patients, and 3 coils in 1 patient, all based on angiographic results. In the AVP group, we used a device that was at least 1 mm larger than the initial fenestration size. No immediate or long-term complications were associated with the procedure or with the closure devices. On final follow-up, 3 of 7 patients (43%) in the coil group had complete closure, and 17 of 17 patients (100%) in the AVP group had complete closure. The AVP showed good results for transcatheter closure of a conduit-type fenestration and was found to perform better than the detachable coil.     

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.     

Transcatheter vascular occlusion of the small patent ductus arteriousus: An alternative method

The current strategies concerning a small (≤2 mm) patent ductus arteriosus (PDA) include surgical ligation, transcatheter implantation of the Rashkind occluder device, or no intervention requiring indefinite endocarditis precautions. Five patients have undergone successful transcatheter closure of a small-caliber PDA utilizing a single 3 mm Gianturco occluder coil as an alternative to surgical ligation. The coil was delivered to traverse the narrowest dimension of the PDA, leaving loops of coil in both the pulmonary and aortic ends of the ductus. All PDAs were successfully occluded, and the duration of hospitalization for all patients was 1 day. At lates follow-up (11±2 months), echocardiography demonstrates complete ductus occlusion in all patients, with no obstruction to left pulmonary arterial or descending aortic flow. Transcatheter coil occlusion of the small ductus is an easily accomplished, safe, effective alternative to surgical ligation, thereby avoiding a lateral thoracotomy incision, shortening hospitalization, and reducting costs.     

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。     

Percutaneous closure of patent ductus arteriosus: complementary use of detachable Cook patent ductus arteriosus coils and Amplatzer duct occluders

 Several different devices were evaluated for the percutaneous closure of patent ductus arteriosus (PDA), and important drawbacks were found in all of them. To overcome these drawbacks, both detachable Cook PDA coils and Amplatzer duct occluders (ADO) were used for the percutaneous closure of PDA. A total of 54 patients underwent transcatheter occlusion of PDA at a median age of 4.5 years (range 0.5–29 years) and at a median weight of 19.5 kg (range 6–69 kg). Three patients were adults. Detachable Cook PDA coils were used in 26 patients with a median PDA diameter of 1.7 mm (range 1.1–2.2 mm) and ADO were used in 28 patients with a median PDA diameter of 3.8 mm (range 1.9–7.5 mm). Devices were successfully implanted in all 54 patients. Complete closure was achieved in 53 of 54 patients (98% closure rate). Median fluoroscopy time was 12 min (range 4–47 min). Conclusion According to our experience, the complementary use of detachable Cook patent ductus arteriosus coils and Amplatzer duct occluders for the percutaneous closure of PDA can be recommended. Received: 12 November 1998 and in revised form: 2 June 1999 / Accepted: 13 July 1999     

Transcatheter Occlusion of Residual Patent Ductus Arteriosus After Surgical Ligation

The reported frequency of residual leaks after surgical ligation of patent ductus arteriosus (PDA) varies from 6% to 23%. Reports on percutaneous closure of PDA also involve patients with residual PDA after ligation, but specific data regarding this type of PDA are rare. Our objective was to assess retrospectively the characteristics of residual PDA relevant to transcatheter closure and occlusion results using three types of occluders. Twelve consecutive patients underwent transcatheter occlusion of residual PDA after surgical ligation at a median age of 4.6 years (range 3.2–44.6 years) and median weight 16.5 kg (range 13–62 kg). Three types of occluder were used: Gianturco coils, detachable Cook PDA coils, and the new Amplatzer duct occluder. The median diameter of residual PDA after ligation was 1.5 mm (range 0.9–4.2 mm). All PDAs were of type A morphology. Thirteen devices were successfully placed in the 12 patients, without embolization. There were no complications. At 1 month and 1 year follow-up all residual shunts were completely closed. Coils are particularly suitable for complete closure of residual leaks after surgical ligation of PDA. A 100% closure rate was achieved with a low number of implanted coils.     

Iatrogenic cardiovocal syndrome caused by transcatheter coil closure of patent ductus arteriosus

Two infants developed hoarseness unexpectedly the day after transcatheter coil closure of a slender patent ductus arteriosus (PDA). The pathogenesis of this complication appears to be similar to that of the classic cardiovocal syndrome. During the intervention, the inappropriately implanted coil might have distorted the slender PDA, thereby causing angulation of the pliable PDA itself and precipitating impingement on the left recurrent laryngeal nerve. Fortunately, both infants recovered spontaneously from the hoarseness within several weeks. At present, the definite underlying neuropathology of this complication is unknown as we have not yet confirmed recovery of the left vocal cord movement by follow-up fibreoptic bronchoscopy. Conclusion: Iatrogenic cardiovocal syndrome could occur in infants after transcatheter coil closure of a slender PDA, using the currently popular 0.038-inch coil. A coil with a smaller diameter might prevent the occurrence of this syndrome.     

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.     

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.