动脉导管未闭分型及其在介入封堵术中的价值评价

目的:研究动脉导管未闭(PDA)的血管造影分型,探讨其在介入治疗中的价值.方法:2002-01-2008-03期间120例PDA患者于封堵术前施行了主动脉弓降部造影术,年龄2～70 (16±2.5)岁,120例患者采用左侧位造影,其中9例患者加摄右前斜20°～50°体位,2例患者加摄左前斜70°～85°体位.将造影结果根据PDA形态及其与主动脉弓降部的夹角进行分型.结果:①根据PDA形态将PDA分为5种类型,漏斗型92例, 最窄直径2～13.9 mm,平均最窄直径(4.0±3.0)mm; 管型16例,平均直径为(6.1±1.3)mm;哑铃型2例,最窄直径分别为2.4、8.0 mm;指型5例,最窄直径为(2.4～5.8) mm ,平均最窄直径为(3.2±1.1)mm;半漏斗型5例最窄直径2.1～5.6 cm,平均最窄直径为(3.5±0.8) mm.②根据PDA与降主动脉的夹角将PDA分为成角型PDA15例及非成角型PDA105例.③封堵器选择:其中98例患者选择标准型Amplatzer导管封堵器、15例患者选择成角型Amplatze导管封堵器、5例选择偏心型导管封堵器.2例选择肌部室间隔缺损Amplatze导管封堵器.④手术成功率及随访结果:手术成功率100%,术后随访6个月无残余分流、封堵器移位及脱落.结论:PDA形态变化多端,PDA长轴与降主动脉夹角不一,认识PDA类型有助于指导介入封堵治疗.

Classification of patent ductus arteriosus and evaluation in the transcatheter treatment

Objective:To study the angiographic appearance of patent ductus arteriosus (PDA) and the value for trancatheter closure treatment. Methods: Between January 2002 and July 2007,120 patients with PDA underwent aortography befor attempted transcatheter closure of PDA,the mean age was 20 years(range 2 to 70 years). Left lateral aortography was performed in 120 patients. Among them, additional aortography in right amterior oblique 200～500 or left anterior oblique 700～850 projection was per formed in 9 and 2 patients, respectively. The patients were grouped based on the rescults of aortog raphy. Results: ①The configuration of PDA was classified into five types, ninty two patients had funnel shape PDA,the mean minimum diameter of PDA was (4. 0±3. 0)mm (rangel-17mm). Sixteen patients had tuber shape PDA ,the mean diameter was (6. 1±2. 3)mm; two patients had dumbbell PDA,the minimum diameters of PDA were 2. 4 mm, 8. 0 mm; five(4. 16%) patients had finger shape PDA , the mean minimum diameters of PDA was (3. 2±1. l)mm(range 2. 4 - 5. 8 mm) ; five(4. 16%) patient had half-funnel shape PDA, the mean minimum diameters of PDA were (3. 5±0. 8) mm(range 2. 1 - 5. 6) mm. ②The configuration of PDA was classified into the angled PDA (15 pateints) and the non-angled PDA (one hundred and five patients,87. 50%) according to the angle between PDA and the aorta. ③120 patients with PDA underwent transcatheter closure with different devices according to the angiocardiography conformation and the angle between PDA and the aorta which included standard Amplatzer duct occluders chosed for 98 patients with PDA, angled Amplatzer duct occluders chosed for 15 patients with PDA, asymmetric duct occluders chosed for 5 patients with PDA and Amplatzer muscular VSD occluders chosed for 2 patients. ④The device was successfully placed in all patients, there are no residual shunts, displacement and fall the device in 120 patents during a follow-up period of 6 months after closure. Conclusion: The morphology of PDA varies considerably, and the awareness of these variations is helpful for trancatheter closure treatment.