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］     

消炎痛血浓度监测在动脉导管未闭治疗中的意义

消炎痛(indomethacin,IND)可引起动脉导管关闭,于1976年由Friendinan等首先报道。近年来国外对利用消炎痛治疗动脉导管未闭(Patent Ductus Arteriosus,PDA)的机理、临床应用及不良反应已有较多的报道。消炎痛确实是有效的治疗PDA药物。且随着药物测定技术和超声心动图的发展,使之变得更为安全、可靠,近几年在发达国家已广泛试用于临床。     

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...     

儿童动脉导管未闭治疗进展

动脉导管未闭是儿童常见先天性心脏病,及时有效治疗可防止肺炎、心力衰竭、感染性心内膜炎、肺动脉高压等并发症的发生.治疗方法包括药物治疗、经导管介入治疗和手术治疗.目前绝大部分动脉导管未闭通过介入封堵可获治愈.     

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％。     

动脉导管未闭发病机制研究进展

动脉导管未闭（PDA）是主肺动脉之间的一种先天性异常通道,是由多种因素参与复杂的病理生理过程,目前对于PDA发病机制和病理变化认识尚不完全清楚,主要集中在血管活性物质、缺氧、离子通道、遗传因素与PDA之间的相互影响和制约关系,这对于早期干预和指导治疗提供一定的理论依据。     

动脉导管支架置入术治疗不同类型新生儿肺动脉闭锁的随访结局

目的总结分析动脉导管支架置入术治疗不同类型新生儿肺动脉闭锁的随访结局。方法回顾性队列研究。纳入2014年4月至2021年6月在上海交通大学医学院附属新华医院接受动脉导管支架置入术患儿共19例为研究对象, 分为室间隔完整型肺动脉闭锁(PA-IVS)和室间隔缺损型肺动脉闭锁(PA-VSD)两组。采用不同血管途径置入动脉导管支架, 术后1、3、6和12个月及以后每年定期随访患儿基本情况和心脏超声心动图评估手术效果。组间比较采用独立样本t检验。结果 19例患儿中12例为PA-IVS, 7例为PA-VSD。两组患儿均为足月儿, PA-IVS组和PA-VSD组患儿出生胎龄分别为(38.8±1.1)和(37.7±1.8)周, 出生体重分别为(3.2±0.4)和(3.4±1.1)kg, 手术时年龄分别为(10±9)和(12±7)日龄, 差异均无统计学意义(均P>0.05)。12例PA-IVS患儿中, 9例经股动脉途径, 3例经股静脉途径成功置入动脉导管支架。7例PA-VSD患儿中, 2例经股动脉途径成功置入, 2例经股动脉途径置入失败, 3例经左颈动脉途径成功置入动脉导管支架。所有患儿术后无血栓...     

Prostaglandin E2 administration in infants with ductus-dependent cyanotic congenital heart disease

Prostaglandin E₂ was administered to 22 newborns with ductus-dependent cyanotic congenital heart disease. Twelve patients had pulmonary atresia and ten simple dextrotransposition of the great arteries. Patients were classified into two groups: group 1 (n=11) received prostaglandin E₂ by the intravenous route (dose: 0.01–0.05 g/kg per min); group 2 (n=11) received prostaglandin E₂ by the oral route (dose: 35–65 g/kg per 1–4 h). Treatment lasted for 1–90 days. All infants except one of group 2 showed a significant (>10 Torr) increase in PaO₂ following PGE₂ administration. The mean increase in PaO₂ was higher (P<0.01) in group 1 (21.8±1.7, Torr) than in group 2 (15.8±1.5, Torr). PaO₂ fell significantly (P<0.01) in five patients of group 1 who continued treatment orally with satisfactory (>30 Torr) levels in four of them. Severe side effects were observed only in group 1. The data show that similarly to prostaglandin E₁ infusions, prostaglandin E₂, given i.v. or orally, is useful in the management of infants with ductus-dependent cyanotic congenital heart disease. Oral prostaglandin E₂, administration is less effective than i.v. infusions, but can be used for long-term, therapy being more convenient and causing minimal morbidity.Presented at the IX European Congress of Perinatal Medicine, Dublin, Ireland, 1984     

胎儿动脉导管、主动脉及肺动脉平滑肌细胞的增殖凋亡及相应细胞信号传导通路研究

目的明确胎儿动脉导管、主动脉及肺动脉平滑肌细胞的增殖及凋亡特性以及相应的ERK1/2和JNK细胞信号传导通路是否存在差异,以及不同胎龄的平滑肌细胞在增殖凋亡及相应细胞信号传导通路是否有差异。方法取6例(18±2)周流产胎儿的主动脉、肺动脉和动脉导管进行细胞培养。通过原位免疫组织化学检测主动脉、肺动脉和动脉导管平滑肌细胞的PCNA、Bax和Bcl-2蛋白表达和通过ELIASA方法检测ERK1/2和JNK细胞信号传导通路的活化(磷酸化)状况。结果①在动脉导管,PCNA、Bcl-2、ERK表达16周胎龄最强,20周胎龄最弱,随胎龄增长而减弱,Bcl-2有统计学意义。不同胎龄主动脉、肺动脉各项指标无差异;②PCNA的表达肺动脉表达最强,主动脉次之,动脉导管最弱;③动脉导管平滑肌细胞在体外培养时比主动脉和肺动脉平滑肌细胞Bax/Bcl-2的比值高;④ERK1/2通路的OD值动脉导管表达最弱,主动脉表达最强。JNK通路的OD值动脉导管表达最强,主动脉表达最弱。结论胎儿动脉导管、主动脉及肺动脉平滑肌细胞在增殖凋亡和其相应的细胞传导通路有着明显的差异,动脉导管平滑肌细胞的生长状况可能随着胎龄的增长而减弱,与出生后动脉导管的闭合是否有关值得我们进一步探讨。     

The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review

Aim: A patent ductus arteriosus (PDA) is associated with morbidity in preterm infants. Treatment is prescribed for a haemodynamically significant duct (HSDA), but its definition varies. We systematically reviewed the clinical and ultrasound criteria used for the definition of an HSDA. Methods: PubMed and the Cochrane library were searched for randomized trials evaluating ductal treatment. The included studies were explored, and we categorized clinical and ultrasound criteria used to define an HSDA. Results: Sixty‐seven trials were included in our review. Forty‐two were placebo‐controlled trials, and 25 were comparative trials. The diagnosis of the PDA was made by clinical examination, followed by ultrasound in most trials. Most trials used clinical and ultrasound criteria to define an HSDA, but there was a wide variety in criteria and cut‐offs used. Of the clinical criteria, a murmur or hyperdynamic circulation was most used, and of the ultrasound criteria, the left‐atrium‐to‐aorta ratio (LA/Ao ratio) was most used. Conclusion: We found a wide variety in the definition of an HSDA. This finding implies that comparison of studies is difficult. International consensus should be reached on the definition of an HSDA, which will make future studies more comparable.     

经导管Amplatzer封堵器治疗小儿动脉导管未闭的随访结果

目的总结经导管Amplatzer封堵器(Amplatzerductoccluder,ADO)治疗小儿动脉导管未闭(patentductusarteriosus,PDA)的远期随访结果,进一步评价应用ADO治疗小儿PDA远期疗效和安全性。方法对1998年4月至2003年12月间接受ADO封堵术的PDA患儿进行回顾性队列研究。结果共有250例PDA患儿接受ADO封堵术,平均年龄5.3(3个月～16岁)岁,平均体重15.1(3.5～35.0)kg。PDA最窄处直径在1.8～11.0mm之间,平均(4.2±1.5)mm,其中52例(20.0%)直径超过5mm。PDA均应用4～14mm大小的ADO进行封堵,输送长鞘为6F(205例)或7F(45例)。250例中,ADO成功植入245例(98.0%)。Qp/Qs从1.90±0.60降至1.03±0.21(P<0.05)。不同形状的PDA均可应用ADO进行封堵。近期并发症5例,其中溶血3例,股动脉血栓2例,无死亡病例。共有205例在堵闭术后完成1天～60个月的随访,随访率为82.0%。残余分流率在不同随访时间点分别为9.2%(1天)、2.8%(1个月)、1.2%(6个月)、0.8%(12个月)、0(24个月)、0(36个月)、0(48个月)、0(60个月)。5例(2.0%)随访中因残余分流出现溶血或无溶血需要再次接受治疗,随访1年和5年无事件发生率为98.0%。结论应用ADO治疗小儿PDA远期疗效确切,安全性好。     

Aneurysm of the ductus arteriosus in the neonate: Three case reports with a review of the literature

Summary Ductus arteriosus aneurysm was demonstrated in three neonates by echocardiography. One case was already diagnosed in utero. One patient needed surgical resection, whereas in one case the aneurysm of the ductus arteriosus regressed spontaneously. In the third case the patient died of associated lesions.In a review of the literature, 61 previous cases of ductus aneurysm in infants less than 2 months were found.Ductus arteriosus aneurysm may be diagnosed by echocardiography both pre- and postnatally. A ductus aneurysm should be monitored closely by echocardiography. Since a high incidence of complications is reported, surgical resection is indicated if the aneurysm does not regress within a few days.     

Exogenous prostaglandin administration and pseudo-Bartter syndrome

Biological abnormalities simulating Bartter syndrome were observed in a preterm neonate with complex cyanotic congenital heart disease, for which ductus arteriosus was maintained open by high doses of prostaglandin (PG) until a Blalock shunt could be performed. These abnormalities spontaneously disappeared after cessation of PG administration. We postulate that the natriuretic effect of exogenous administered PG could further increase sodium wasting already induced by the cardiopathy thus leading to pseudo-Bartter syndrome.