经导管介入治疗冠状动脉瘘

目的：探讨经导管介入治疗冠状动脉瘘的方法及临床疗效。方法：经导管堵塞冠状动脉瘘14例，平均年龄7．1岁。结果：13例应用弹簧圈堵塞，平均瘘口大小为3．65mm，除3例失败外均获成功；1例（瘘口6．6mm）应用Amplatzer动脉导管未闭堵塞器堵塞成功。所有病例随访1个月－4年，均无残余分流及任何并发症。结论：经导管介入治疗冠状动脉瘘具有良好的临床疗效及安全性。可控弹簧圈一般用于堵塞瘘口较小的冠状动脉瘘，而瘘口较大的冠状动脉瘘可选用Amplatzer动脉导管未闭堵塞器。     

关于婴幼儿动脉导管未闭介入治疗的临床研究

目的：探讨Amplatzer法介入封堵治疗婴幼儿动脉导管未闭（PDA）的经验，治疗意义，操作技术及安全性。方法：回顾性分析32例婴幼儿PDA患儿资料，患儿年龄≤3岁，平均（13±5．5）月，体重（10．3±4．2）kg；做右心导管，实行封堵术，术后24h，1、3、6、12月复查超声心动图。结果：32例患儿中29例（90．6％）封堵成功，PDA最窄处直径（4．2±2．1）mm。失败者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大量残余分流，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，介入封堵婴幼儿动脉导管未闭较为安全，可行。     

经皮穿动脉导管堵塞术的临床应用

１８例动脉导管未闭（ＰＤＡ）患者，年龄７岁～４７岁，平均２３．２±２．６岁，对其采用改进的Ｐｏｒｓｔｍａｎｎ法实施经皮穿刺堵塞术。以彩色多普勒，气囊导管探测未闭导管的大小，结合导管卡尺测量塞子并实施堵塞术。１４例关闭成功，其血流动力学各参数均明显改善或恢复正常。随访１年～７年无栓子移位或再分流发生。在未闭导管关闭后约３０ｍｉｎ时易出现心动过缓，血压下降甚至发生休克。早期处理可避免这一并发症。此方法易于确定未闭导管的实际内径，可避免单凭造影测量的误差，疗效可靠。失败４例:１例未闭导管呈反漏斗型，１例塞子过小，脱入肺动脉，经送至股静脉并切开取出；另２例系股动脉太细而不能送入选定的塞子。１例因压迫过度发生股动脉血栓，经手术去除。     

经导管Rashkind双伞闭合器关闭动脉导管未闭

应用经导管Ｒａｓｈｋｉｎｄ双伞闭合器半闭５例先天性动脉导管未闭（ＰＤＡ）患者，１例杂音即刻消失，主动脉造影未见分流，４例术后心脏杂音明显减轻，主动脉造影及彩色多普勒血流显像示ＰＤＡ处有微量残余分流，其中２例术后２个月复查杂音消失，超声多普勒检查证实无残余分流。经导管Ｒａｓｈｋｉｎｄ闭合器闭合ＰＤＡ是一种简单、安全、有效的方法。     

经导管介入治疗婴幼儿大型动脉导管未闭临床疗效

目的探讨应用导管介入治疗直径≥5mm婴幼儿大型动脉导管未闭（patent ductus arteriosus．PDA）的临床疗效。方法回顾性分析60例大型PDA（直径≥5mm）患儿的临床资料,着重分析手术方法、临床疗效和随访结果。结果56例PDA采用Amplatzer或国产先健动脉导管封堵器．3例采用膜部室间隔缺损封堵器,1例采用肌部室间隔缺损封堵器。封堵成功率为98．3％（59／60）,术后1d超声心动图显示15％（9／60）微量至少量残余分流,术后3月超声心动图复查未见残余分流：3例采用室间隔缺损封堵器患儿术后12月超声心动图示左肺动脉血流速度增快。结论应用导管介入治疗直径≥5mm婴幼儿大型PDA是安全、有效的方法。     

未闭动脉导管经皮弹簧栓栓堵方法的临床研究

目的：研究建立一种经皮可释放性弹簧栓栓堵治疗动脉导管未闭（ＰＤＡ）的新方法。方法：经主动脉造影测定ＰＤＡ内径及长度，在Ｘ线和超声心动图监测引导下，经心导管将可释放性弹簧栓栓堵于ＰＤＡ。分别采用Ｊａｃｋｓｏｎ弹簧栓（Ｊ组）和ＰＤＡ弹簧栓（Ｐ组）。经临床、主动脉造影和超声心动图确定疗效。结果：采用本法治疗２１例，ＰＤＡ平均最狭窄处内径３．１８±０．６２ｍｍ（范围１．５～４．７ｍｍ，其中８１％超过３ｍｍ），平均长度５．１７±２．１３ｍｍ。２０例获得成功且无并发症，术后经临床、主动脉造影和超声心动图检查，无残余分流。其中Ｊ组８例均获成功；Ｐ组１３例，成功１２例、失败１例。结论：本法属于安全可靠的非开胸治疗ＰＤＡ的新方法，创伤性很小，值得使用。     

动脉导管未闭患者介入治疗的观察与护理

目的：探讨护理介入治疗封堵动脉导管未闭（PDA）患者的效果。方法：回顾性分析、总结22例Amplatzer堵闭器封堵动脉导管未闭（PDA）的护理经验。结果：护理有效地配合治疗，22例均封堵成功（100％），其中19例PDA即刻完全封堵无残余漏，3例有10％残余漏，经对症处理，2个月后残余漏消失。结论：术前做好患者的心理护理，重点把握术后24h的护理，严密观察病情，做好穿刺伤口及肢体的护理，有助于保证动脉导管未闭的封堵成功。     

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。     

应用Amplatzer封堵器经导管治疗动脉导管未闭开胸术后再通的疗效评价

目的 :应用 Am platzer封堵器经导管治疗动脉导管未闭 （PDA）开胸术后再通并对其疗效进行评价。方法 :全组10例 ,年龄 11± 8（4～ 32 ）岁。PDA最窄处直径为 4± 4（2～ 13） mm。封堵后 10 m in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 :9例 PDA采用 Am platzer PDA封堵器治疗 ,1例采用 Amplatzer房间隔缺损封堵器治疗。术后 10 m in降主动脉造影显示 ,3例存在微量～少量残余分流 ,7例封堵完全无残余分流。术后 2 4h、术后 1月超声心动图均未见残余分流及再通。结论 :应用 Amplatzer封堵器治疗动脉导管未闭外科术后再通是一种安全有效的介入方法。     

经皮穿刺动脉导管闭合术的临床应用及并发症的处理

采用改进的Ｐｏｒｓｔｍａｎｎ法对８例动脉导管未闭（ＰＤＡ）患者实施经皮穿刺堵塞术。以彩色多普勒探测ＰＤＡ大小，结合导管尺测量塞子并实施堵塞术。６例关闭成功，其血液动力学各参数均明显改善或恢复正常。随访２～４年无栓子移位或再分流发生。失败２例：１例未闭导管呈反漏斗型，塞子脱入肺动脉，经送至股静脉并切开取出；另１例系股动脉太细而不能送入选定的塞子。因此，严格选择适应症的患者是非常重要的。     

Surgical Closure of Patent Ductus Arteriosus in Preterm Low Birth Weight Infants

Background and Aim of the Study. In many preterm low‐birth‐weight infants, ductus arteriosus fails to close spontaneously. This study evaluates the results of surgical ligation of symptomatic patent ductus arteriosus (PDA) in preterm low birth weight infants. Methods. We reviewed the medical records of all infants undergoing surgical closure of PDA from January 1987 to December 2005. Demographic data, age and weight at operation, surgical technique to close PDA and outcome were analyzed. Results. One hundred and forty‐five infants underwent surgical closure of PDA in which either indomethacin treatment had failed or was contraindicated. The mean gestational age was 25.5 ± 2.3 (range 24–36 weeks) and the mean birth weight was 837.7 ± 277.2 g (450–1000 g). The average age and weight at operation were 14.1 (±1.8) days and 881.7 g (±338.1), respectively. PDA was surgically closed by left thoracotomy using either nonabsorbable suture (73%) or hemoclips (27%). Postoperative complications occurred in 10 patients, which included intraoperative bleeding (6), pneumothorax (1), left vocal cord paralysis (1), lymphatic leak (1), and injury to left phrenic nerve (1). There was no mortality related to surgical closure of PDA. Conclusion. We conclude that surgical closure of hemodynamically significant PDA is safe and effective in preterm low birth weight infants when pharmacological treatment is ineffective or contraindicated. The associated morbidity is minimal and no surgery‐related mortality was observed.     

Closure of the ductus arteriosus with indomethacin in ventilated neonates with respiratory distress syndrome. Effects of pulmonary compliance and ventilation

The reported effects of indomethacin on pulmonary compliance are variable depending upon the patient population and on the degree to which indomethacin resulted in successful ductal closure. Eleven fluid-restricted, furosemide-treated premature infants being mechanically ventilated for respiratory distress syndrome (RDS) who also had a significant patent ductus arteriosus (PDA) had pulmonary function testing performed before and after successful closure of the PDA. The diagnosis of a significant PDA was made by clinical and echocardiographic criteria. Indomethacin was administered at a dosage of 0.2 mg/kg/dose every 12 to 18 h for 1 to 3 doses. To control for the 48-h time interval to achieve ductal closure, nine premature infants being ventilated for RDS but who did not have a significant PDA also had pulmonary function evaluations performed before and after the 48 h. Also, to control for the independent effect of fluid restriction and diuretic therapy on pulmonary compliance, eight such premature infants with a PDA had pulmonary function evaluations performed at a 48-h interval. Successful closure of the ductus with indomethacin was associated with an improvement in compliance and ventilation parameters in all infants in the indomethacin-treated infants. In the indomethacin-treated group, the mean percent improvements were noted in the following parameters: CLdyn, 59.2%; CLI, 78.3%; CLE, 63.3%; VT, 63.3%; VE, 54.6%. There were no significant changes in the pulmonary functions in the 48-h RDS or the 48-h PDA fluid-restricted, furosemide-treated control groups. In conclusion, successful closure of the ductus with indomethacin causes a significant improvement in compliance and ventilation parameters in infants being mechanically ventilated for RDS.     

Effect of oral ibuprofen on patent ductus arteriosus in premature newborns

Background aim of the studyPatent ductus arteriosus (PDA), a common finding among premature infants, is conventionally treated by intravenous indomethacin. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reactions in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route. This study was designed to determine whether oral ibuprofen treatment is efficacious and safe in closure of a PDA in premature infants.Patients and methodsThirty-three premature group I (study group) were treated with ibuprofen 10 mg/kg administered through a feeding tube. Thirty-three premature group II (control group) receive placebo the two imaging procedures were again performed 24 h after each ibuprofen dose. When the PDA was still hemodynamically significant, as demonstrated by echocardiography, and there was no evidence of deterioration in brain ultrasonography, a second dose of ibuprofen 5 mg/kg (placebo for control) was administered. A third equivalent dose was given after another 24 h if necessary. Cranial ultrasound was repeated 1 week after the last ibuprofen dose and again before discharge from the ward. Hematochemical analysis was preformed daily in the unit during the first days of life.ResultsIn the study group the rate of PDA closure was 93.9% (31 of 33 cases) while in the control group the rate of PDA closure was 30.3% (10 of 33 cases) with significant difference in between. There was no reopening of the ductus after closure had been achieved. No infant required surgical ligation of the ductus in study group while in the control group 24.2% (8 of 33 cases) were required surgical ligation (Table 2). Twenty-one newborns were treated with 1 dose of ibuprofen, 9 were treated with 2 doses, and the remaining 3 were treated with 3 doses.ConclusionOral ibuprofen is an effective and safe alternative to intravenous ibuprofen for PDA closure in premature infants.     

Management of patent ductus arteriosus in preterm infants.

OBJECTIVE: To evaluate the incidence of symptomatic patent ductus arteriosus (PDA) in preterm infants, and the results of the intravenous indomethacine treatment and surgery. METHODS: Among 394 preterm infants (<37 weeks), symptomatic PDA was diagnosed by echocardiography in 51 babies and they were examined retrospectively. All infants were managed conservatively and then IV indomethacine was given to non-responders (n=30). Surgical closure was performed in 12 babies. RESULTS: The incidence of symptomatic PDA in preterm infants was 12.9%: median age: 3 days, mean birth weight: 1434+/-540 g (540-2900g) and mean gestational age (GA) 30.9+/-3.3 weeks (23-37 weeks). With indomethacine, ductal closure was achieved in 70% infants. Early clinical improvement was observed in all cases that underwent surgery and most of them had a low birth weight (<1500 g) and an early gestational age (<32 weeks). None of them died due to operation. CONCLUSION: The incidence of symptomatic PDA is high in preterm infants. Treatment with indomethacine improves ductal closure and is associated with few reversible adverse effects. In the other hand, early clinical improvement and high success rate were achieved after surgery. If indomethacine fails to achieve ductal closure, decision of surgery must be made immediately.     

Predictive Value of Blood N-Terminal Pro-Brain Natriuretic Peptide Concentrations for Early Patent Ductus Closure in Very Preterm Infants

ObjectivesIt has been shown that blood concentrations of NT-proBNP may be useful in identifying preterm infants at risk of hemodynamically significant patent ductus arteriosus and its complications. The aim of the study was to assess predictive value of serum NT-proBNP levels for early ductus arteriosus (DA) closure in very preterm newborns.MethodsFifty-two infants <32 weeks’ gestation aged <72 hours with patent ductus arteriosus (PDA) diameter >1.5 mm were involved in a randomized study. Twenty-seven (52%) of them were treated with ibuprofen or paracetamol starting within the first 3 days of life. Expectant management was applied to 25 (48%) infants. All patients underwent planned echocardiographic (daily) and two serum NT-proBNP measurements within the first 10 days after birth. Depending on the DA closure within the first 10 days of life, 2 groups of patients were formed retrospectively, with closed (n = 30) or patent (n = 22) DA by this age.ResultsIn the first 10 days of life, DA closure occurred in 19 (70%) treated infants and in 11 (44%) infants managed expectantly (p > 0,05). Initial concentrations of NT-proBNP were significantly higher in infants that had patent ductus arteriosus (PDA) at 10 days of life. By the eighth day, median NT-proBNP values in both groups significantly decreased but remained considerably higher in newborns with PDA. NT-proBNP serum concentrations on the second day of life could reliably predict DA closure within the first 10 days after birth in treated babies (the AUC was significant 0.81 [95% CI: 0.58–1.03], p < 0.05) but not in infants who were managed expectantly.ConclusionsSerum NT-proBNP concentrations on the second day of life could reliably predict early PDA closure in treated but not in expectantly managed very preterm infants.     

Non-surgical closure of patent ductus arteriosus in children with the Rashkind double disk occluder

Since the first clinical application of transcatheter closure technique for patent ductus arteriosus in children and infants in 1977 by Rashkind and Coll., this technique is routinely performed only in a few major Pediatric Cardiology Centers. We report our successful series which is the first of its kind both in Italy and in Southern Europe. The series included 11 children aged 1.6 to 10 years (mean age 4.5 years) all affected with patent ductus arteriosus (PDA). Subaortic stenosis (1) and ventricular septal defect with pulmonary stenosis (1) were associated anomalies. In all of the cases, after the standard percutaneous cardiac catheterization, the Mullins method was attempted to advance and deliver the Rashkind PDA double-disk occluder. Successful closure was accomplished in 10 while almost complete closure was achieved in the 11th. Normal Doppler flow pattern after the procedure confirmed the successful results. No complications occurred. Although our experience is limited, non-surgical PDA closure provided an excellent alternative to surgical procedure.     

Patent ductus arteriosus in preterm newborns: A tertiary hospital experience

IntroductionPatent ductus arteriosus (PDA) in preterm infants has been associated with increased mortality and comorbidities. This study aimed to characterize the population of preterm infants diagnosed with PDA and to identify predictive factors of response to medical treatment of PDA.MethodsAn eight-year retrospective observational study was carried out, which included all preterm infants with a gestational age (GA) between 23 and 32 weeks diagnosed with PDA, admitted to the Neonatal Unit of the CHUSJ. Univariate comparative analysis was performed, and models for predicting the effectiveness of PDA treatment with ibuprofen were explored by multivariate logistic regression analysis.Results115 cases were included and 34 were excluded, with a final sample of 81 preterm infants with PDA. The univariate analysis revealed significant differences in the closure efficacy via medical treatment with ibuprofen in several variables, and a multivariate logistic regression model was obtained (discriminative capacity 72.2%, sensitivity 98.1%, specificity 57.1%), taking into account the effect of GA, type of delivery, need for diuretics treatment and platelet transfusion.ConclusionThis study enabled the population of preterm infants diagnosed with PDA to be characterized and the identification of a predictive model that can help predict the efficacy of medical treatment and thus contribute to optimizing the medical approach to the non-responders.     

极低体重早产儿动脉导管未闭的治疗

目的:探讨极低体重早产儿动脉导管未闭(PDA)的治疗方法。方法:本研究回顾性分析6例经外科手术治疗的PDA的极低体重早产儿的临床特点。结果:4例患者布洛芬治疗失败、2例患者因药物禁忌行动脉导管结扎术,术后由对呼吸机依赖转为3～4d过渡脱机,胃肠内喂养耐受性及体重增加显著改善[(45±41)∶(258±77)g/周,P<0.001],5例存活患者均无手术并发症,1例患者死于早产儿并发症。结论:对于有手术指征的PDA的极低体重早产儿,外科手术结扎是安全而有效的方法。     

Echocardiographic guidance for transcatheter patent ductus arteriosus closure in extremely low birth weight infants

Echocardiographic imaging provides real‐time guidance during transcatheter patent ductus arteriosus (PDA) closure in extremely low birth weight (ELBW) infants. Transthoracic echocardiogram provides detailed assessment of the PDA and surrounding structures prior to, during, and after transcatheter closure. This article aims to review the different echocardiographic techniques and concepts utilized during transcatheter PDA closure in ELBW infants.     

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.