应用Amplatzer封堵器经导管治疗直径≥8mm动脉导管未闭的疗效评价

目的 :应用 Amplatzer封堵器经导管治疗直径≥ 8mm的大型动脉导管未闭 （PDA）并对其疗效进行评价。方法 :全组 5 0例 ,年龄 2 6 .4± 2 3.2 （4.0～ 6 0 .0 ）岁。 PDA最窄处直径为 10 .2± 2 .3（8.0～ 15 .0 ） mm。封堵 10 m in后行侧位降主动脉造影 ,术后 1d及 1月行超声心动图检查 ,观察有无残余分流及 PDA再通。结果 :47例 PDA采用Amplatzer PDA封堵器治疗 ,2例采用 Amplatzer ASD封堵器治疗 ,1例 PDA伴有阻力性肺动脉高压未行介入治疗。术后 10 min降主动脉造影显示 ,19例存在微～少量残余分流 ,30例封堵完全无残余分流。术后 2 4h、术后 1月超声心动图未见残余分流及再通。结论 :应用 Am platzer封堵器治疗直径≥ 8mm的大型动脉导管未闭是一种安全有效的介入方法。     

青少年动脉导管未闭合并差异性发绀治疗观察△

目的探讨对单纯性动脉导管未闭合并重度肺动脉高压伴有差异性发绀的青少年患者在联合靶向降肺压治疗下实施封堵术后的疗效。方法回顾性分析3例动脉导管未闭合并重度肺动脉高压和差异性发绀、接受经导管动脉导管未闭封堵术,并联合靶向降肺压药物治疗患者封堵动脉导管未闭前、后的肺动脉压力、肺循环阻力情况及术后随访情况。结果封堵术后3例患者肺动脉收缩压[（102±21）mmHg／）S．（124＋11）mmHg,P=0．125]、肺总阻力[（17．35±4．79）Wood US．（21．31±3．41）Wood,P=0．125]、肺小动脉阻力[（15．61±4．77）Wood US．（19．39±3．18）Wood,P=0．125]及超声估测肺动脉收缩压[（102＋37）mmHgm（111±34）mmHg,P=0．750]与封堵前比较,差异无统计学意义。3例患者中1例术前行肺活检,提示为肺动脉高压Heath-EdwardsI-Ⅱ级病理改变。3例封堵术后血氧饱和度均上升至正常,治疗后短期内生活质量提高,术后1年后起则频繁出现右心功能衰竭或因肺血管梗阻性病变引起频繁咯血,2例在术后3年余死亡。结论当动脉导管未闭合并重度肺动脉高压患者出现差异性发绀时,在联合靶向降肺压治疗的前提下,实施动脉导管未闭封堵术短期内能提高患者生活质量,但并不能改善生存时间及预后。进行肺活检了解肺血管病变程度时．建议多点取材,结合右心导管检查结果进行综合评价,对合并重度肺动脉高压的患者治疗后应该长期随访,客观评价其治疗效果。     

经导管封堵治疗动脉导管未闭伴重度肺动脉高压

目的评价经导管封堵术治疗动脉导管未闭伴重度肺动脉高压病人的临床疗效与安全性。方法选择在我院接受经导管封堵术治疗且肺动脉收缩压在80mmHg或以上，肺动脉平均压在60mmHg或以上的动脉导管未闭病人31例，回顾性分析病人术中及术后随访资料。结果31例病人术前肺动脉收缩压80～183（112±28）mmHg，肺动脉平均压63～130（82±22）mmHg。其中30例经导管封堵成功（成功率97％），1例巨大型动脉导管未闭因无合适封堵器而行手术治疗。封堵后10min，26例肺动脉收缩压下降30mmHg以上，2例肺动脉收缩压下降20％以上，另2例肺动脉收缩压无明显改变。1例用房间隔缺损封堵器封堵巨大型动脉导管未闭，在术后3d复查心脏超声时发现封堵器脱人肺动脉而转入外科手术治疗；在5例双向分流者中，1例于术后2个月因重度肺部感染死亡，1例于封堵后血氧饱和度明显增加，但肺动脉压无明显下降，术后2年出现右心功能不全表现。结论动脉导管未闭伴重度肺动脉高压病人，若心脏超声检查示左向右分流，可用经导管封堵术进行根治；但若为双向分流时，经导管封堵治疗应慎重。     

Lung perfusion studies after transcatheter closure of persistent ductus arteriosus with the Amplatzer duct occluder

Background : Reduced left lung perfusion has been described after transcatheter closure of the patent ductus arteriosus (PDA) with several prostheses. Although the Amplatzer ductal occluder (ADO) device is currently the most widely used occluder for closure of large‐sized PDAs, the potential consequences of flow distribution to the lungs of this device have not been completely clarified. We evaluated lung perfusion following occlusion of PDA with the ADO device. Methods : Forty‐seven patients underwent successful transcatheter PDA occlusion using the ADO device were included in this study. Lung perfusion scans were performed 6 months after the procedure. Results : Decreased perfusion to the left lung (defined as < 40% of total lung flow) was observed in 17 patients (36%), 5 of whom were low‐weight symptomatic infants. Ductal ampulla length was significantly shorter and minimal ductal diameter to ampulla diameter ratio was significantly higher in patients with decreased left lung perfusion and correlated well with left lung perfusion values (r = 0.516 and r = ?0.501, respectively). A cut‐off value of ≤5.8 mm for the ductal ampulla length and ≥1.9 for ampulla diameter to ampulla length ratio showed high sensitivity and specificity for reduced lung perfusion. Conclusions : The incidence of abnormal left lung perfusion is high 6 months after transcatheter closure of PDA with the ADO, more likely in the low weight symptomatic infants and in patients with a short duct or a relatively shallow duct having abrupt narrowing of a large ampulla. © 2010 Wiley‐Liss, Inc.     

Subclinical aortic perforation with the infant double-button patent ductus arteriosus occluder.

Modification of the double-button (Sideris) patent ductus arteriosus (PDA) occluder has resulted in a single-strut aortic component rather than the conventional cross-strut design. We report the use of this infant PDA occluder for transcatheter closure in three patients with PDA measuring 2 mm, 3.7 mm, and 4 mm. Subclinical aortic perforation with a small aortic aneurysm developed in two patients 1 year after occluder implantation. The third patient had developed a small aortic aneurysm without perforation at 3-month follow-up. All three patients had a residual shunt and underwent successful PDA surgical closure with aortic aneurysmal repair. Single-strut umbrella designs are not recommended for PDA transcatheter closure.     

国产封堵器介入治疗动脉导管未闭的临床分析

目的总结应用国产封堵器治疗动脉导管未闭的临床疗效。方法本组动脉导管未闭患者10例,男4例,女6例,年龄3~55岁,体重10.5~54 kg,平均肺动脉压33~49 mm Hg。降主动脉侧位造影显示病理解剖类型为管型8例,漏斗型2例,最窄处直径2~8 mm,应用国产封堵器经静脉途径行封堵术。术后超声心动图随访。结果10例患者均成功封堵,术后即刻完全封堵9例,1例有少量残余分流,术后24小时彩色多普勒超声检查示分流消失,肺动脉压均有下降,随访无严重并发症。结论国产封堵器治疗动脉导管未闭是一种安全有效的方法。     

应用国产封堵器治疗动脉导管未闭的临床疗效

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。     

Safety and efficacy of transcatheter closure of large patent ductus arteriosus in adults with a self-expandable occluder

Most occurrences of large patent ductus arteriosus (PDAs) of ≥10 mm have been surgically closed, and transcatheter closure of these large PDAs was only reported in a few case reports. The present study reviewed our experience in transcatheter closure of such large PDAs with a Chinese self-expandable occluder, which is similar to but much cheaper than the Amplatzer occluder. From July 2000 to January 2008, 23 patients underwent transcatheter closure of large PDA ≥10 mm with this kind of occluder. The mean (SD) age of the patients was 38.0 (15.6) years (range 18–75 years). Radiographs of the chest, electrocardiograms, and echocardiograms were used for follow-up evaluation of the treatment within 1 day, 1 month, 6 months, and then every year after successful closure. The mean (SD) angiographic PDA diameter was 12.8 (2.6) mm (range 10–18 mm) and the mean occluder diameter was 18.0 (2.9) mm (range 16–22 mm). The occluders were delivered successfully and closed the PDA completely in 19 out of the 23 patients. Pulmonary arterial pressures decreased significantly after occlusion in patients with successful treatment: 67.3 (24.7) mmHg (range 29–122 mmHg) before occlusion and 42.3 (22.0) mmHg (range 19–98 mmHg) immediately after the procedure. Radiographs of the chest and echocardiograms showed that the diameters of the left atrium, left ventricle, and the main pulmonary artery decreased, and the ejection fraction (EF) increased at a mean (SD) follow-up of 36.3 (18.7) months (range 6–72 months). No severe complication occurred. The immediate and long-term outcomes suggested that transcatheter closure of PDAs with the native PDA occluder is a safe and effective treatment for adults with large PDA ≥10 mm.     

经导管介入性治疗动脉导管未闭68例临床疗效分析

目的 :应用Amplatzer堵闭器经导管介入性治疗动脉导管未闭 (PDA)并对其疗效进行初步分析。方法 :于主动脉弓降部造影 ,测量PDA大小 ,在透视下经传送装置将Amplatzer堵闭器置入PDA内 ,使之在PDA最窄处固定 ,即刻或 10min后再次造影。术后 2 4h行超声心动图 (UCG)检查。结果 :全组技术成功率 10 0 %。术后 6 1例 (89 7% )即刻无分流 ;7例 (10 3% )即刻有少量残余分流 ,其中 4例术后2 4hUCG示分流消失 ;肺动脉高压者术后均有所下降。结论 :应用Amplatzer堵闭器治疗动脉导管未闭操作方法简便、治疗范围广、成功率高 ,不失为很有前途的代替开胸手术的介入性治疗方法     

Transcatheter closure of patent ductus arteriosus in piglets

To better determine the risks of transcatheter closure of a patent ductus arteriosus (PDA), a model of PDA was made in newborn piglets by using 5- to 7-mm angioplasty catheters to dilate the probe PDA. This maneuver resulted in a permanent PDA in most piglets. Four to 6 weeks later PDA closure was attempted using the Rashkind PDA occluder. Twelve such procedures were attempted, using clean but nonsterile technique. Nine of 12 PDAs were successfully closed. Two failures were the result of inability to successfully traverse the PDA. This problem was solved by using a long sheath to position the device properly. Four complications occurred, all related to device release: left pulmonary artery embolization in 1 case, femoral artery embolization in 1, torn pulmonic valve cusp in 1 and lodgment of a prosthesis on a pulmonic valve cusp. Two successfully implanted devices were infected at necropsy. This study demonstrates the value of a piglet model in testing transcatheter PDA occlusion devices, the importance of sterile technique in such procedures, the hazards of device retrieval through the right heart and the feasibility of transcatheter PDA closure.     

Amplatzer封堵器介入治疗动脉导管未闭疗效分析

目的 评价Amplatzer封堵器介入治疗动脉导管未闭(PDA)的临床疗效。方法 对10例管型PDA患儿用Amplatzer PDA封堵器进行堵闭，2例窗型PDA用Amplatzer房间隔双伞封堵器堵闭。在透视下经6F输送器置入封堵器，术后10分钟，行右心导管检查及主动脉弓降部造影，术后24小时、1、3个月分别行彩色多普勒超声心动图、血常规及肝肾功能检查，评价治疗效果。结果 本组技术成功率为100％，患儿心脏双期连续性杂音均消失，术后10分钟主动脉弓降部造影显示少量残余分流2例，均为窗型PDA。术后24小时超声心动图示上述2例仍有微量分流。术后24小时、1、3个月行彩色多普勒超声心动图检查，均未发现残余分流、PDA再通及封堵器移位，血常规及肝肾功能检查均正常。2例有分流的患儿术后均出现急性溶血，经积极内科治疗后好转。其余10例无并发症发生。结论 应用Amplatzer封堵器介入治疗PDA安全有效，近中期疗效满意，远期疗效尚待进一步观察。对窗型PDA可试用Amplatzer房间隔封堵器堵闭。对术后发生急性溶血者可采用内科治疗。     

Comparison and results of transcatheter closure of patent ductus arteriosus using the swivel-disk device versus plug occluder in children

The transcatheter closure of certain types of patent ductus arteriosus (PDA) remains a challenge. The investigators report initial clinical experience with 25 patients who underwent PDA occlusion with the use of a swivel-disk device (SDD) or a plug occluder (PO). The patients were divided into 2 groups: in the SDD group, 12 patients aged 1 to 2 years with type A PDA underwent attempted closure using the SDD, a modified Amplatzer duct occluder with a very low profile retention disk that can adapt itself at different PDA insertion angles. The mean PDA diameter was 4.8 +/- 1.5 mm (range 3.8 to 8). In the PO group, 13 patients aged 0.5 to 3 years with type C, D, or E PDA underwent attempted occlusion with the PO, a tubular occluder made of Nitinol wire mesh. The mean PDA diameter was 4.2 +/- 3.5 mm (range 1.2 to 9). The 2 occluders are filled with Dacron patches. The mean device diameters were 6.5 +/- 1.2 and 6.8 +/- 2.2 mm (range 4 to 11) in the SDD and PO groups, respectively. Complete angiographic closure was seen in 24 of 25 patients. The deployment of 4 5-PDA5 coils abolished a residual shunt associated with hemolysis in a 5-month-old patient with a large type C PDA after the implantation of an 11-mm PO. No other complications were observed. In conclusion, the SDD and the PO are promising additions to the armamentarium for PDA closure.     

应用国产封堵器治疗儿童大型动脉导管未闭的疗效研究

目的:评价应用国产封堵器经导管治疗儿童大型动脉导管未闭的安全性及有效性。方法:12岁以下大型动脉导管未闭患儿66例,应用国产封堵器经导管进行介入治疗,于术后1、3、6月及每年进行超声心动图等随访,观察有无残余分流及主动脉狭窄等,评估该方法的效果及安全有效性。结果:技术成功率97%。应用目前最大封堵器失败转外科手术1例,由于重度肺动脉高压,试封堵后肺动脉压力无明显改善而放弃治疗1例。手术即刻残余分流率为23%,随访观察1月后为3%,6月后所有64例患儿均无残余分流。结论:国产封堵器经导管治疗儿童大型动脉导管未闭安全可行。     

Patent ductus arteriosus equipment and technique. Amplatzer duct occluder: intermediate-term follow-up and technical considerations

Between May 1997 and June 2000, 69 patients, ages 0.1 to 34 years, underwent attempted anterograde transcatheter closure of a patent ductus arteriosus (PDA) using the Amplatzer Duct Occluder (ADO). The ADO is a cone-shaped, self-centering, and repositionable occluder made of nitinol wire mesh. A 5Fr to 7Fr sheath was used for the delivery of the device. The mean PDA diameter (at the pulmonary end) was 4.6 +/- 1.9 mm (range 1 mm-8.5 mm). Sixty-seven of the 69 patients had successful device placement. The mean ADO smallest diameter was 6.9 +/- 1.8 mm (range 4 mm-12 mm). Complete angiographic closure occurred in 62 (92.5%) of 67 patients (95% confidence interval, 88.22%-98.77%). In five patients, there was a trivial residual shunt immediately after the procedure. At 24 hours, color Doppler flow imaging revealed complete closure in all 67 (100%) patients. The unsuccessful attempts occurred in two patients with a small, 1-mm diameter native PDA and residual PDA after surgical occlusion. Fluoroscopy time was 7.6 +/- 1.8 minutes (4 min-18 min). No complications were observed. At a median follow-up of 1.5 years (range 0.25 to 3.2 years), all patients had complete closure without complications. We conclude that transcatheter closure using the ADO is a highly effective and safe treatment for most patients with PDA.     

Transcatheter closure of large patent ductus arteriosus using custom made devices

There has been a paradigm shift in the transcatheter closure of patent ductus arteriosus (PDA) over the last 45 years. With the availability of various coils, plugs and occluders, PDA of almost all shapes and sizes are amenable to transcatheter closure. However, very large PDA diagnosed late in life are being referred for surgical closure in the absence of availability of large size devices, especially in developing countries. In this case series, we have described four patients with large PDA, three of which were closed by transcatheter custom made PDA occluders. © 2014 Wiley Periodicals, Inc.     

Further experience with transcatheter closure of the patent ductus arteriosus using the Amplatzer duct occluder

OBJECTIVE: The aim of this study was to report further experience with transcatheter closure of the patent ductus arteriosus (PDA) using the Amplatzer duct occluder (ADO). BACKGROUND: The design of previously used devices is not ideal for this purpose, and their use has been associated with several drawbacks, especially in large PDAs. METHODS: Forty-three patients, aged 0.3 to 33 years (mean 6.4+/-6.7 years), with a moderate to large, type A to E PDA, underwent attempted transcatheter closure using the ADO. The device is a plug-shaped repositionable occluder made of 0.004-in. nitinol wire mesh. It is delivered through a 5F to 6F long sheath. The mean PDA diameter (at the pulmonary end) was 3.9+/-1.2 mm (range 2.2 to 8 mm). All patients had color flow echocardiographic follow-up (6 to 24 months) at 24 h, 1 and 3 months after closure, and at 6-month intervals thereafter. RESULTS: The mean ADO diameter was 6.1+/-1.4 mm (range 4 to 10 mm). Complete angiographic closure was seen in 40 of 43 patients (93%; 95% confidence interval [CI] 85.4% to 100%). The remaining three patients had a trivial angiographic shunt through the ADO. At 24 h, color flow mapping revealed no shunt in all patients. A 9F long sheath was required for repositioning of a misplaced 8-mm device into the pulmonary artery. The mean fluoroscopy time was 7.9+/-1.6 min (range 4.6 to 12 min). There were no complications. No obstruction of the descending aorta or the pulmonary artery branches was noted on Doppler follow-up studies. Neither thromboembolization nor hemolysis or device failure was encountered. CONCLUSIONS: Transcatheter closure using the ADO is an effective and safe therapy for the majority of patients with patency of the arterial duct. Further studies are required to establish long-term results in a larger patient population.     

Transcatheter closure of moderate to large patent ductus arteriosus with the Amplatzer duct occluder.

OBJECTIVES: To investigate the acute and follow-up results of transcatheter closure of moderate to large patent ductus arteriosus (PDA) with the Amplatzer duct occluder. METHODS: Between April 2000 and June 2005, 237 patients underwent attempted transcatheter closure of PDA, of whom Amplatzer duct occluder was used in 68 patients with moderate-to-large-sized PDA (45 females, with ages ranging from 56 days to 75 years, median 3.3 years). Moderate to large PDA is defined as ductus diameter > or =2.5 mm (> or =3 mm in early phase of this study) in infants and young children, or > or =4 mm in adolescents and adults. The size of device selected was generally at least 1-2 mm larger than ductus diameter. RESULTS: The ductus diameter ranged from 2.5 to 8.5 mm (4.1 +/- 1.3 mm). Amplatzer duct occluder was successfully deployed in 66 out of 68 patients. The size of device deployed ranged from 4 to 12 mm (6.3 +/- 1.6 mm). The causes of failure in the 2 patients included calcification of ductus resulting, in failure in advancing a sheath to descending aorta in 1 and kinking of a Cook sheath in the other. Distal embolization of the device occurred several hours later in one. After the device was retrieved percutaneously, the patient was sent to surgery. No other significant complications occurred. In the 3-month follow-up, complete occlusion was achieved in all patients. No patient had left pulmonary artery stenosis. CONCLUSIONS: Transcatheter closure of moderate-to-large-sized ductus with Amplatzer ductus occluder is effective and safe.     

Amplatzer蘑菇伞器治疗儿小动脉导管未闭的临床应用

目的：探讨应用Amplatzer蘑菇伞器治疗小儿动脉导管未闭（PDA）的临床疗效及价值。方法：本组共68例,年龄8个月－12岁（平均6．4岁）,体重6．5－30（平均18．2）kg,PDA直径为3－8mm,术中行右心导管检查取血,测压,术后5－15min行隆主动脉造影,测肺动脉压,主动脉压。术后1月,3月,6月分别行X线及超声心动图检查,了解有无残余分流及封堵器位置。结果：本组68例均应用AmplatzerPDA蘑菇伞器治疗,成功率100％,疗效满意,无并发症,术后3d行超声心动图检查显示无1例分流。结论：应用Amplatzer蘑菇伞器治疗PDA创伤小,操作简单,使用广泛,成功率高,临床疗效满意。     

Retrograde wire-assisted percutaneous transcatheter closure of persistent ductus arteriosus with Amplatzer duct occluder in the elderly: A new application.

Percutaneous transcatheter closure of persistent ductus arteriosus (PDA) has been well established in the pediatric field. For moderate- to large-sized PDA, the newly developed Amplatzer duct occluder had offered a good solution, but it depends on stiff wire and delivery sheath. We reported two elderly patients of PDA with vascular anatomy too difficult to be antegradely approached and were closed by a retrograde technique by an assisting wire from the descending aorta. The wire served as a guide and tracked the delivery system to cross the ductus from the venous side smoothly. This retrograde wire-assisted technique could be utilized to overcome the PDA of difficult vascular anatomy, which could not be easily fulfilled by conventional antegrade venous approach.     

Transradial approach for percutaneous closure of patent ductus arteriosus with the Amplatzer duct occluder II: A case report

Percutaneous patent ductus arteriosus (PDA) closure is a safe and feasible treatment, and it is recommended over surgical approach in the majority of cases. Amplatzer duct occluder (ADO—AGA Medical Corporation, Golden Valley, MN) is the preferred device for transcatheter treatment of PDA. Recently, the ADO II (AGA Medical Corporation, Golden Valley, MN), allowing PDA closure through a small delivery catheter from an antegrade or retrograde approach, received the European Community mark approval. Here, we report, for the first time, successful PDA closure in a 66‐year‐old female with the ADO II device, using a transradial approach. © 2010 Wiley‐Liss, Inc.