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目的 观察应用国产蘑菇伞型封堵器介入治疗动脉导管未闭(PDA)的临床疗效.方法 198例PDA患者于主动脉弓降部造影,测量动脉导管大小,在透视下经传送装置将国产蘑菇伞型封堵器置入动脉导管内,使之在动脉导管处固定,即刻造影,术后行超声心动图(UCG)检查.结果 全组成功196例,技术成功率99%;主动脉弓造影即刻无分流146例;50例存在微量或少量残余分流,经UCG复查,其中25例术后48 h分流消失,22例术后1个月分流消失,3例术后3个月分流消失;封堵术后即刻肺动脉平均压由封堵前(42.8±16.4)mmHg下降至(31.3±14.5)mmHg(P<0.05);术后3个月心室舒张末期容积均较术前缩小(94.2±28.4)mL vs(112.5±31.5)mL,(52.1±12.4)mL vs(61.0±15.7)mL(P<0.05).结论 应用国产蘑菇伞型封堵器治疗动脉导管未闭操作方法简便,治疗范围广,成功率高. 相似文献
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目的: 评价国产蘑菇伞经导管介入治疗成人动脉导管未闭(PDA)的临床疗效。方法: 选择我科156(男54,女102)例成人PDA实施经导管介入治疗的患者,年龄18~65(32±13)岁;体质量43.8~68.5(51±8)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1.5~18.2 (5±5)mm。以国产蘑菇伞堵闭器行介入治疗,根据封堵实验决定能否行永久封堵。术后24 h、1、3、6 和12个月行彩色多普勒超声心动图检查随访。结果: 4例封堵后30 min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。余152例成功地植入封堵器,术后30 min肺动脉压收缩压由术前(48±23)mmHg降为(36±12)mmHg(P<0.05),肺动脉平均压降由术前(40±14)mmHg降为(27±11)mmHg(P<0.05),主动脉压由术前(102±13)mmHg变化至(107±14)mmHg(P>0.05)。术后30 min主动脉弓降部造影显示,119例(78.3%)封堵完全,33例(21.7%)可见极少量残余分流,术后24 h心脏彩超复查147例(96.7%)封堵完全,5例(3.3%)有少量残余分流,术后1个月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: 在不可逆性阻力性重度肺动脉高压发生前应用国产蘑菇伞经导管封堵治疗成人PDA是一种安全、简便、有效、创伤小、恢复快的方法。 相似文献
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目的评价国产封堵器经导管介入治疗小儿动脉导管未闭(PDA)并发肺动脉高压的临床疗效。方法回顾分析2003年12月2007年11月86(男30,女56)例小儿PDA并发肺动脉高压实施经导管介入治疗;年龄8月12(8±7)岁;体质量1146(31±8)kg;行左、右心导管检查及主动脉弓降部造影,确定PDA位置、形状及大小,PDA最窄处内径413(7±5)mm。以国产蘑菇伞堵闭器行介入治疗,根据封堵实验决定能否行永久封堵。术后24h、1个月、3个月、6个月、1年行彩色多普勒超声心动图检查。结果2例(2%)封堵后30 min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。余84例(98%)术后30 min肺动脉压收缩压由术前平均(69±24)mmHg(1mmHg=0.133 kPa)降为(36±14)mmHg(P<0.05),肺动脉平均压由术前(45±14)mmHg降为(30±8)mmHg(P<0.05),主动脉压由术前(94±10)mmHg升至(99±6)mmHg,但无统计学差异。术后30min主动脉弓降部造影显示,18例(21%)可见极少量残余分流,术后24h心脏彩超复查4例(4%)有少量残余分流,术后1月彩超复查皆无残余分流;无严重并发症发生。结论国产蘑菇伞经导管封堵治疗儿童PDA并发肺动脉高压,安全、有效,值得推广应用。 相似文献
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目的评价经导管封堵治疗巨大型动脉导管未闭(patent ductus arteriosus,PDA)合并重度肺动脉高压(pulmonary hypertension。PH)患者的疗效及安全性。方法应用蘑菇伞PDA封堵器对18例巨大型PDA合并重度PH的患者进行试封堵,封堵成功后进行定期临床随访。随访内容包括临床症状、心功能情况、肺动脉压力变化。患者于术后1d,1、3、6、12个月以及每年复查x线胸片、心电图和超声心动图。结果18例患者中,12例巨大型PDA均封堵成功,6例未能成功封堵。成功封堵的12例患者的PDA最小直径为(14.4±2.7)mm,所选择的蘑菇伞PDA封堵器肺动脉端直径为(15.7±3.9)mm;封堵前后肺动脉收缩压由(90.2±17.7)mmHg(1mm Hg=0.133kPa)降至(45.4±13.8)mmHg,差异有统计学意义(P〈0.001);封堵前后主动脉压力变化差异无统计学意义[(123.3±14.3)/(72.6±8.7)mmHg vs.(124.0±14.5)/(74±8.0)mmHg,P〉0.05];封堵后的外周血氧饱和度较封堵前略有升高,但差异无统计学意义(98.30%±1.00%vs.96.80%±1.38%,P〉0.05)。术后第1天复查超声心动图,结果提示6例左心室、左心房和主肺动脉直径明显缩小,3例左心室、左心房直径明显缩小,其余3例左心室、左心房和主肺动脉直径无明显改变,其中有3例可见残余少量分流:X线胸片提示肺充血情况均有所减轻。术后随访1—3年,全部患者无胸闷、气促发作,复查超声心动图提示无或仅有少量残余分流。6例未能成功封堵的患者,其中3例为双向分流,临床可见分界性发绀,试封堵时肺动脉压无明显下降或升高;3例试封堵后有大量残余分流。结论经导管封堵治疗巨大型PDA合并重度PH患者是可行的,短、中期疗效理想,远期疗效尚需观察;术中试封堵时必须严密监测患者症状、血氧饱和度以及肺动脉、主动脉压力。 相似文献
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目的:总结青海地区介入封堵治疗巨大型动脉导管未闭(PDA)并发肺动脉高压的体会。方法:用国产封堵伞封堵巨大型PDA 105例,动脉导管平均直径(16.4±3.2)mm,肺动脉平均压为(63.5±3.9)mmHg(1mmHg=0.133kPa),术后随访2个月~8年。结果:本组患者均成功置入国产封堵伞,无术后并发症。术后造影示PDA均完全封堵,7例少量残余漏;术后1周、1、3、6、12个月复查超声心动图提示,98例PDA分流消失,7例有微少量残余漏,肺动脉平均压为(32.0±2.5)mmHg;所有患者心功能均明显改善,活动量明显增加。结论:介入治疗巨大型PDA并发肺动脉高压安全、可靠,近期疗效良好,是一种可优先选择的治疗方法。 相似文献
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目的应用国产封堵器经导管治疗巨大动脉导管未闭(PDA)并对其疗效进行评价。方法全组27(男8,女19)例,年龄6~54(24±15)岁,主动脉造影示PDA最窄径为13~28(16±4)mm。封堵后即刻和30min行侧位降主动脉造影,术后2d,1、3、6个月分别行超声心动图及X线平片检查。结果24例成功,3例PDA封堵后判断为有阻力性肺动脉高压,放弃治疗。成功的患者中,14例选用国产PDA封堵器,10例选用国产ASD封堵器。术后即刻降主动脉造影检查示,使用ASD封堵器中,有2例微量残余分流,5例少量残余分流,1例少~中量残余分流;PDA封堵器中,有4例微量残余分流,2例少量残余分流。术后30min,ASD封堵器4例微~少量残余分流,1例仍为少~中量残余分流;PDA封堵器仅2例微量残余分流。1例ASD封堵器治疗术后7h发生溶血,治疗72h溶血无减轻迹象,外科开胸取出封堵器并行PDA结扎术。术后2d,超声心动图示PDA封堵器1例微量残余分流,ASD封堵器5例微量残余分流。随访1~6个月,所有左心内径增大的患者均明显回缩,未发现残余分流和导管再通。结论应用国产封堵器经导管治疗直径≥13mm的PDA是一种安全有效地介入方法。 相似文献
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目的 评价应用国产封堵器封堵治疗巨大动脉导管未闭(PDA)的疗效.方法 全组17例,男性8例,女性9例,年龄15~43(24.5±11.1)岁.主动脉造影示PDA最窄腰部内径为18~26(25.5±1.8)mm,需采用腰部直径20mm以上的封堵器方可操作成功.术后3d及3个月后复查超声心动图.结果 术前超声诊断,17例中6例合并重度肺动脉高压,17例患者中14例(其中5例合并重度肺动脉高压)封堵成功(操作和临床成功),成功率为82%(14/17).16例选用国产特制PDA封堵器,1例26 mm ASD因封堵器位置不能牢固地“站稳”而放弃封堵治疗;1例严重肺动脉高压且左向右分流为主存在少量右向左分流,经封堵试验为阻力性肺动脉高压不适宜治疗;1例术后第2天发生封堵器脱落入降主动脉,经捕获器成功取出体外,但死于误吸(迷走反射引起恶心呕吐)导致的严重肺部感染及感染性休克.封堵成功14例,封堵器直径为22~30(26.5±2.7)mm,术后即刻降主动脉造影检查示9例微量残余分流,均为封堵器中间存在云雾状分流,10 min后重复造影云雾状分流消失.术后3d及术后3个月超声心动图示患者所有左心内径增大均明显回缩,未发现残余分流和导管再通.结论 巨大PDA在可能的范围内尽量争取介入治疗,成功后较普通PDA血液动力学恢复更明显,可获得较好的收益/风险比. 相似文献
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摘要:目的:评价应用国产封堵器经导管介入封堵治疗动脉导管未闭(PDA)的疗效和安全性。方法:采用Amp一|atzer法对182例PDA患者经不同介入途径分别进行经导管介入封堵术。术中术后测肺动脉压力,以经胸超声心动图评价术后24~48h封堵结果、左心室舒张末内径(LVEDd)并随访1~12月并发症发生情况。对合并室间隔缺损、房间隔缺损者同时进行介入治疗。结果:本组患者封堵成功178例(97.8%),其中经常规途径封堵143例(80.3%),经建立动静轨道途经封堵22例(12.4%),经单静脉途径封堵13例(7.3%)。术中封堵术15min后残余少量分流4例,微量分流12例。与术前比较,所有封堵成功患者术后平均肺动脉压明显降低[mPAP,(32.3±15.7)mmHg比(21.1±9.9)mmHg,P〈0.05]。术后24~48h复查心脏彩超示1例存在微量分流,LVEDd明显减小[(50.8±8.9)mm比(47.2±7.1)mm,P〈0.053。随访1~12(4.2±1.5)月无残余分流、死亡病例或其他严重并发症。结论:应用国产封堵器介入治疗动脉导管未闭安全、有效,近中期疗效确切。 相似文献
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目的应用肌部室间隔缺损封堵器经导管治疗婴幼儿动脉导管未闭(patent ductus arteriosus,PDA)合并重度肺动脉高压(severe pulmonary hypertension,SPH),并对其疗效进行评价。方法选择2004年1月至2011年3月在温州医学院附属第二医院住院的16例PDA合并SPH患儿为研究对象。男6例,女10例,月龄6~47个月,中位月龄16.3个月;体质量(7.6±2.2)kg。行左、右心导管检查及主动脉弓降部造影,确定PDA位置、形状及大小,PDA最窄处直径为(4.7±1.5)mm。选用肌部室间隔缺损封堵器进行治疗,封堵后行侧位降主动脉造影,术后24 h及1、3、6个月分别行超声心动图检查观察疗效。结果所有患儿均封堵成功,成功率达100%。术后即刻主动脉弓降部造影显示,1例可见极少量残余分流,15 min后重复造影见分流消失。术后24 h超声心动图复查2例有少量残余分流;术后1个月超声心动图复查皆无残余分流、PDA再通,降主动脉无缩窄。16例封堵后肺动脉收缩压由(72.9±4.3)mm Hg(1 mm Hg=0.133 kPa)降至(48.4±12.0)mm Hg,差异有统计学意义(P<0.05);肺动脉平均压由(48.8±5.6)mm Hg降至(30.4±10.8)mm Hg,差异有统计学意义(P<0.05)。封堵术后24h,左心室舒张末期内径、左心室舒张末期容积均较术前减少,差异有统计学意义(P<0.05),随访期间上述指标呈减少趋势;左心室射血分数于封堵术后24 h较术前升高,随访期间呈上升趋势。结论经导管治疗PDA合并SPH是一种安全有效的方法。 相似文献
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目的通过总结经皮介入封堵治疗低龄低体质量婴幼儿动脉导管未闭(PDA)的临床经验,探讨其治疗意义、操作技术及安全性。方法回顾性分析105例动脉导管未闭患儿,行右心导管检查,测体、肺动脉压力,行主动脉弓降部造影显示PDA直径、形状,选择封堵器,实施封堵,术后24h,1、3、6、12个月复查超声心动图。结果 105例患儿中102例封堵成功,成功率97.1%,PDA最窄径(4.1±2.5)mm。2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例封堵术后封堵器周围中量残余分流,行外科手术治疗。并发症包括术后残余分流、股动脉搏动减弱及伤口出血等。结论在严格选择适应证的条件下,介入封堵低龄低体质量婴幼儿动脉导管未闭较为安全、可行。 相似文献
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Shyam Sathanandam Ashley Gianinni Eric Sefton Kaitlyn Greer Nathan Stecchi Kimberly Allen Ranjit Philip B. Rush Waller 《Congenital heart disease》2019,14(1):85-89
Objective: The objective of this article is to describe a live case transmission of tran‐
scatheter closure of a patent ductus arteriosus (PDA) in an extremely low birth weight
(ELBW) infant during the first International PDA Symposium conducted in Memphis,
Tennessee.
Setting: A multidisciplinary team approach including audiovisual specialists, informa‐ tion technology specialists, physicians, nurses, and other health care specialists was required to perform the transcatheter PDA closure (TCPC) in an ELBW infant at LeBonheur Children’s Hospital and the procedure was broadcast live to the attend‐ ees at the International PDA Symposium allowing for a two‐way audiovisual discus‐ sion during the procedure.
Patient: The patient was a 14 days old 24‐week premature ELBW infant, who weighed 700 g at the time of the procedure. The patient was requiring mechanical ventilation secondary to pulmonary hemorrhage. The PDA measured 4 mm in diameter and 12 mm in length.
Interventions: TCPC was performed safely without any procedural complications using a specialized minimally invasive technique.
Outcome Measures: The patient was weaned off the ventilator in < 7 days after the procedure. The child was discharged 9 weeks after the procedure (35 weeks’ cor‐ rected gestation) weighing 2.2 kg, on full oral feeds and no supplemental oxygen.
Results: The successful TCPC allowed for this child to have an uneventful hospital course. The case also highlights the technical nuances involved in setting up the live transmission.
Conclusions: This case demonstrated to the audience in the International PDA Symposium the feasibility and safety of performing TCPC in an ELBW infant. Live cases are useful in exhibiting the nuances involved in any new technique and allows for best learning experience. 相似文献
Setting: A multidisciplinary team approach including audiovisual specialists, informa‐ tion technology specialists, physicians, nurses, and other health care specialists was required to perform the transcatheter PDA closure (TCPC) in an ELBW infant at LeBonheur Children’s Hospital and the procedure was broadcast live to the attend‐ ees at the International PDA Symposium allowing for a two‐way audiovisual discus‐ sion during the procedure.
Patient: The patient was a 14 days old 24‐week premature ELBW infant, who weighed 700 g at the time of the procedure. The patient was requiring mechanical ventilation secondary to pulmonary hemorrhage. The PDA measured 4 mm in diameter and 12 mm in length.
Interventions: TCPC was performed safely without any procedural complications using a specialized minimally invasive technique.
Outcome Measures: The patient was weaned off the ventilator in < 7 days after the procedure. The child was discharged 9 weeks after the procedure (35 weeks’ cor‐ rected gestation) weighing 2.2 kg, on full oral feeds and no supplemental oxygen.
Results: The successful TCPC allowed for this child to have an uneventful hospital course. The case also highlights the technical nuances involved in setting up the live transmission.
Conclusions: This case demonstrated to the audience in the International PDA Symposium the feasibility and safety of performing TCPC in an ELBW infant. Live cases are useful in exhibiting the nuances involved in any new technique and allows for best learning experience. 相似文献
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Management of patent ductus arteriosus in extremely preterm infants remains a topic of debate. Treatment to produce ductal closure was widely practiced until the past decade, despite lack of evidence that it decreases morbidities or mortality. Meta‐analyses of trials using nonsteroidal anti‐inflammatory drugs have shown effectiveness in accelerating ductal closure, but no reduction in neonatal morbidities, regardless of agent used, indication, timing, gestational age, or route of administration. Surgical ligation closes the ductus but is associated with adverse effects. Recent experience with conservative approaches to treatment suggest improved neonatal outcomes and a high rate of spontaneous ductal closure after discharge. Careful postdischarge follow‐up is important, however, because potential adverse effects of long‐standing aortopulmonary shunts may be an indication for catheter‐based ductal closure. Identification of extremely preterm infants at greatest risk of potential harm from a persistently patent ductus, who may benefit most from treatment are urgently needed. 相似文献
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Closure of very large PDA with pulmonary hypertension: Initial clinical case‐series with the new Occlutech® PDA occluder
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Anja Lehner MD Sarah Ulrich MD Christoph M. Happel MD PhD Marcus Fischer MD Marinos Kantzis MD Ingram Schulze‐Neick MD PhD Nikolaus A. Haas MD PhD 《Catheterization and cardiovascular interventions》2017,89(4):718-725